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Covid 19 Form

 

* Date (This screening form must be completed on the day of your session)
* First and Last Name
* E-mail address
* Telephone number
* Have you had a recent onset of any of the following symptoms?
Please selected at least 1 answer
 
 
 
 
 
 
 
* In the last 14 days have you:
Please selected at least 1 answer
 
 
 
 
 
I AGREE to all of these terms:
Wear a mask in the building at all times, unless being photographed.
Wash and/or sanitize your hands upon entry and again upon exit of the building.
Notify us if you have received, or come in to close contact with someone who has received a positive COVID-19 test in the last 30 days.
Notify us if you receive a positive COVID-19 test within 30 days after your session with us.

 

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