PRE-SCREENING FORM

Pre-screening Questionnaire
Have you tested positive for any type of contagious infection in the past 14 days or have you had contact with a person with a contagious infection without wearing appropriate PPE?
Are you experiencing or have you experienced any of the following in the past 14 days, including fungal, viral or bacterial infections:
You must check and agree to all of the following prior to being approved for an appointment:
By submitting this form, you confirm that you have answered truthfully and agree to the above terms

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