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Clinical Services Health Screening Survey

Clinical Services Health Screening Survey  

Please fill out the information on the form below in it's entirety. This will ensure prompt scheduling of your appointment


The Lehman Center (York)
Francis Leiter Center (Chambersburg)
The Nicarry Center (New Oxford)
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Client and Guest Screening Questions 
Cough Shortness of Breath Chest Tightness
Sore Throat Nasal Congestion/Runny Nose Myalgia (Body Aches)
Loss of Taste and Smell Diarrhea Nausea
Vomiting Fever/Chills/Sweats No symptoms present
Alabama Arizona Arkansas
California Florida Georgia
Idaho Iowa Kansas
Louisiana Mississippi Missouri
Nevada North Carolina Oklahoma
South Carolina Tennessee Texas
Utah Wyoming

Children's Aid Society Administrative Office

343 Lincoln Way West, New Oxford, PA 17350

Phone: 717-624-4461
Fax: 717-624-3011

Administrative Office

343 Lincoln Way West New Oxford PA 17350
Phone: 717-624-4461



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