New York Cancer & Blood Specialists

Are you feeling sick today?

In the last 10 days, have you had a COVID-19 test becauase you had symptoms and are still awaiting your test results or been told by a health care provider or health department to isolate or quarantine at home due to COVID-19 infection, exposure or travel?

Have you been treated with antibody therapy or convalescent plasma for COVID-19 in the past 90 days (3 months)?

Have you ever had an immediate allergic reaction (e.g. hives, facial swelling, difficulty breathing, anaphylaxis) to any vaccine, injection, or shot or to any component of the COVID-19 vaccine, or a severe allergic reaction (anaphylaxis) to anything?

Have you had any vaccines in the past 14 days (2 weeks) including flu shot?

Are you pregnant or considering becoming pregnant?

Do you have cancer, leukemia, HIV/AIDS, a history of autoimmune disease or any other condition that weakens the immune system?

Do you take any medications that affect your immune system, such as cortisone, prednisone or other steroids, anticancer drugs, or have you had any radiation treatments?

Do you have a bleeding disorder or are you taking a blood thinner?

Have you received a previous dose of the COVID-19 vaccine?