Skip to content
Raising the bar for excellence in CBT. Enroll in Beck Institute CBT Certification today!

Self-Screening Questionnaire

Beck Institute COVID-19 Self-Screening Questionnaire/Form



CURRENT SYMPTOMS

In the past 72 hours, have you experienced:












IF YOU ANSWERED YES TO ANY OF THE SYMPTOMS LISTED ABOVE, DO NOT GO INTO WORK, AND IMMEDIATELY CONTACT JULIE SNOW-REGAN AND CC CAROLYN HANIF.

ADDITIONAL EXPOSURES

In the past 14 days...




IMPORTANT: IF YOU ANSWERED “YES” TO ANY OF QUESTIONS 1 – 4 ABOVE, PLEASE CONTACT JULIE SNOW-REGAN AND CC CAROLYN HANIF AND AWAIT FURTHER INSTRUCTION AND/OR FOLLOW-UP INFORMATION REQUESTS. 

By checking the below, I acknowledge and agree that...