COVID-19 QUESTIONAIRE

COVID-19: UPDATES FOR OUR AFL BABES. READ MORE.

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Full Name?

Phone Number?

Email address?

City?

Today's Date

Date of Appointment

Are you currently experiencing:

Fever

Body Aches

Sore Throat

Headaches

Diarrhea or Flu Symptoms

Coughing or Shortness of Breath

None of the Above

Check any that apply to you:

Been in Contact with a COVID positive patient

Waiting for COVID Testing Results

Traveled to High Risk States or Outside the U.S in the Last 4 Weeks?

None of the Above

In efforts to reduce risk, we are asking for all clients to avoid bringing any extra guests and please make sure you wear a mask during the duration of your appointment. Thank you!

I have answered these questions honestly and I read and agree to follow the regulations outlined above.

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PLEASE SECURE APPT PRIOR TO MAKING TRAVEL ARRANGEMENTS

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