NEW JERSEY'S Most Technologically Advanced Provider of Imaging Services Schedule an Appointment Survey FormDo you have any of the following symptoms? (Check all that apply) Fever (>100.0 degrees F) Cough Chills Shortness of Breath Headache Sore Throat Runny Nose Congestion Vomiting Diarrhea Muscle Ache Malaise (a general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to identify) Shaking Chills Loss of Taste Loss of Smell I do not have any of the above symptomsFirst Name*Last Name*
