Client Health Questionnaire
1. Exposure
Have you had contact with anyone with confirmed COVID-19 in the last 14 days?

2. Symptoms
Do you currently have, or have you experienced any of the following symptoms in the last 14 days?
• Fever greater than 100
• Difficulty breathing
• Cough 

*Face coverings required for all in person appointments.*
Question 1 - Exposure*
Yes - Contact Us
Question 2 - Symptoms*
Yes - Contact Us