25 Newbridge Rd, Suite 302, Hicksville, NY, 11801         Tel : 516.367.2266,   Fax : 516.367.1067

COVID-19 Disclaimer

The safety of our employees and our clients at Cottage Home Care Services is our priority. As the Coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidance from the Centers for Disease Control and Prevention and local health authorities.

In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our workforce and our clients we are asking everyone to respond to this document truthfully and to the best of your ability.



  1. This is to attest that I did not experience any of the following symptoms in the past 14 days:
    • Fever
    • Cough
    • Shortness of breath or difficulty breathing
    • Sore Throat
    • New loss of taste or smell
    • Chills
    • Head or muscle aches
    • Nausea, diarrhea, vomiting
  2. In the past 14 days , I have not been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since contact.
  3. In the past 14 days ,I have not been in close proximity to anyone who was tested positive for COVID-19

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