Visitor Pre-Screen

  • :
  • MM slash DD slash YYYY
  • :
  • Pre-Screen

    Please answer the following questions:
  • If you marked "YES" to any of the above, your visit will be postponed for atleast 14 days from the day your symptoms began.

    If you marked "NO" to all of the above BUT become symptomatic within 3 days of your visit, please contact the facility immediately at 815-844-6131.


    I received information on social distancing and the importance of wearing a face mask. I agree to stay at least 6 feet away from the resident I am visiting, wear a face mask during the visit, and perform hand hygiene.