Innovations Client Health Screening

Home
Make a Referral
Services
Our Team
- Join Our Team
Payments
Contact Us
DWU Portal

Your Child's Name: *

Shortness of breath: *

Yes

Thank you for your response! If you answered "yes" to any questions, Betsy will be in contact with you. Thank you for your help and support as we try to keep everyone safe and healthy!

Are you or anyone in your home waiting on the results of a Covid test? *

Yes

Has your child, or anyone in your home, had any of the following symptoms within the last week?

Important Information!

Masks should be worn at all times when clients are with staff. This includes riding in the car together, when out in the community, in the DWU office or in the client's home.

Additionally, if you have any questions regarding your answers to the health screener questions, please reach out to your QP right away. Thanks!

New muscle pains/aches (not related to another condition or exercise): *

Yes

Stomach troubles such as diarrhea or vomiting (not related to another medical condition): *

Yes

Body shakes or chills: *

Yes

Staff Name: *

New loss of taste or smell?: *

Yes

Fever over 100: *

Yes

New or worsening cough (not related to another medical condition such as allergies or asthma): *

Yes

Within the last 14 days, has your child or anyone in your home come in contact with someone who is COVID-19 positive or has COVID-19 symptoms? *

Yes

Health & Wellness Screening

Please complete the following before your Innovations staff arrives today. Results will be sent directly to Blayke Turrubiartes, Communications Director at Dreamweavers. If you answer yes to any of the questions, you may be contacted by Betsy to discuss the circumstances.

Thank you for your patience and cooperation as we all work together to keep our Dreamweavers staff and clients safe and healthy!

View on Mobile

Copyright © Dreamweavers Unlimited. All rights reserved.