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COVID-19 Informed
    Consent Form
I understand the COVID-19 virus has a long incubation period during which carriers of the virus are asymptomatic. Our determination to service clients is based on present health conditions. *
Have you had a fever of 100F or higher in the last 24 hours? *
Do you now, or have had recently, any respiratory or flu symptoms, sore throat, runny nose, shortness of breath? *
Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus symptoms? *
Have you been tested for COVID-19? *
If yes, what were your results?

Thanks for submitting!

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