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Clinical Services Health Screening Survey

The Lehman Center (York)
Francis Leiter Center (Chambersburg)
The Nicarry Center (New Oxford)
Pick a date
Chills Sweats
Felt Feverish Temperature greater than 100 degrees Farenheit
Loss of taste/smell Cough
Shortness of Breath Headache
Diarrhea Muscle Pain
Sore Throat Vomiting
None of the Above
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Alabama Arizona Arkansas
California Florida Georgia
Idaho Iowa Kansas
Louisiana Mississippi Missouri
Nevada North Carolina Oklahoma
South Carolina Tennessee Texas
Utah Wyoming None of the Above/Did not travel

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

 

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
Email: info@cassd.org

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