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Covid-19 Health Declaration

How are you feeling today?

*Please complete and submit for any in person visits. Thank you

First Name

Last Name

Email

Phone

My body temperature is lower than 98.6°F/37.5°C

I am not experiencing any of rhese symptoms: fever, cough, sore throat, body aches, headaches or chills.

I haven't been in close contact with a Covid-19 patient in the last 14 days.

Initials

Today's Date

I accept terms & conditions

Thanks for submitting!

If you are a new client, please click on the
"New Client Registration" button below to complete a registration form

New Client Registration

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