Precautionary COVID-19 Health Check Form

​Due to the 2019-2020 outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices.

​Please complete the following before EACH appointment.
Symptoms of COVID-19 include:
  • Fever
  • Fatigue
  • Dry cough
  • Shortness of breath/difficulty breathing
  • Chills 
  • Nausea or vomiting 
  • Diarrhea 
  • Confusion
  • New widespread muscle pain 
  • Headaches 
  • Loss of taste & smell 
  • Bruising, redness, swelling, or cramping in lower legs and feet 
  • Red or purple toes