Book Appointment (516) 579-4949
  • Address

    3000 Hempstead Tpke #112,
    Levittown, NY 11756 US

    Phone
    (516) 579-4949
  • Address

    3000 Hempstead Tpke #112,
    Levittown, NY 11756

Book Appointment (516) 579-4949
(516) 579-4949

COVID-19 Screening Form

Dr. Michael A.Bernstein
Chiropractor
3000 Hempstead Turnpike, Suite 112
Levittown, NY 11756
(516) 579-4949 Phone (516) 579-5078 Fax
[email protected]

COVID-19 Screening Form

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1. Do you currently have fever or respiratory symptoms such as a cough or shortness of breath?
2. Have you been in close contact with a person known to have the 2019 Novel Coronavirus?
3. Have you and/or the patient been asked to self-quarantine?
4. Have you traveled within the USA in the last 14 days?
5. Have you or traveled outside of the USA in the last 14 days?
6. Have you and/or the patient been in close contact with anyone who has traveled domestically or internationally in the last 14 days?
7. Have you attended any events or gatherings with more than 100 people?
8. Have you been on a cruise ship in the last 14 days?
9. Do you have any new onset of cold symptoms such as a cough and runny nose?
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Please do not submit any Protected Health Information (PHI).

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    Long Island Back & Neck Care

    Address

    3000 Hempstead Tpke #112,
    Levittown, NY 11756

    Phone

    (516) 579-4949

    Contact Us Today

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    Please do not submit any Protected Health Information (PHI).

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      Office Hours

      Monday  

      9:00 am - 1:00 pm

      Tuesday  

      9:00 am - 1:00 pm

      3:00 pm - 7:00 pm

      Wednesday  

      9:00 am - 1:00 pm

      Thursday  

      9:00 am - 1:00 pm

      3:00 pm - 7:00 pm

      Friday  

      Closed

      Saturday  

      8:00 am - 12:00 pm

      Sunday  

      Closed

      3000 Hempstead Tpke #112
      Levittown, NY 11756

      (516) 579-4949