COVID-19 InformationClient NameDate MM slash DD slash YYYY COVID-19 InformationHave you had a fever in the last 24 hours of 100°F or above? Yes NoDo you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath? Yes NoHave you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus symptoms? Yes NoCOVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.Client SignatureReset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY Parent/Guardian Signature (in case of a minor)Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY
