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RE BNY Resources | April 15, 2021Health Questionnaire Screening Form for Coronavirus (COVID-19)The Real Estate Board of New York (RE BNY) has put together this Coronavirus (COVID-19) Health Screening
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Read each question carefully and ensure you understand what information is being asked for.
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Answer each question to the best of your ability and with honesty.
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Provide any necessary personal information such as name, date of birth, and contact information.
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If you are unsure about a question, ask a medical professional or staff member for clarification.
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Who needs health questionnaire screening form?

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Individuals visiting a healthcare facility for the first time.
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Patients scheduled for a medical procedure or treatment.
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Employees reporting to work in healthcare settings.
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Travelers entering certain countries that require health screening.
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The health questionnaire screening form is a document used to gather information about an individual's health status, medical history, and any potential risks related to health.
Individuals applying for health insurance, certain medical treatments, or those participating in specific programs or activities may be required to file a health questionnaire screening form.
To fill out the health questionnaire screening form, read each question carefully, provide accurate responses regarding your health history and current condition, and ensure all sections are complete before submitting.
The purpose of the health questionnaire screening form is to assess an individual's health risks, determine eligibility for coverage or participation, and tailor health plans or interventions appropriately.
Information typically reported includes personal details, medical history, current medications, lifestyle habits, symptoms, and any relevant health concerns.
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