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CO​VID-19 Requirements & Protocols

This form must be completed the day of your appointment. If you have experienced any of these in the symptoms in the past 14 days please answer yes. If you answer yes to any of the following your appointment will have to be rescheduled until your symptoms have been resolved without medication for at least 72 hours, or at least 14 days after contact with a person sick with the symptoms below or diagnosed COVID-19.


COVID-19 Precaution Questions


Do you have or have you had any cold or flu-like symptoms in the last 14 days?*
Do you have a new or worsening cough, sore throat or runny nose?*
Are you experiencing chills with or without body aches?*
Have you experienced any shortness of breath?Radio Button List*
Have you recently lost your sense of smell or taste?*
Are you experience acute digestive issues such as abdominal pain, diarrhea or vomiting?*
Are you experience unusual fatigue that is not relieved by sleep?*
Do you have conjunctivitis or pink eye?*
Do you have any sores or blisters on your toes?*
Do you have a rash or lesions?*
Have you been in close contact with anyone with these symptoms or anyone who has been diagnosed with COVID-19 in the past 14 days? *
Are you currently living with someone is sick or quarantining?*
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REQUIREMENTS & PROTOCOL:

*Bring a mask, it will be required to be worn the entire time you are in the building.

*Please wait in your car until I text you 5 to 10 minutes before your appointment time. I will then meet you at the door to let you in. If you are running late, please text me to let me know and then again when you've arrived so I can meet you at the door.

*Upon arrival your temperature will be taken with a no touch thermometer. If your temperature is above 100 degrees Fahrenheit your appointment will be rescheduled.

*After entering you will need to go into the bathroom and wash your hands for a minimum of 20 seconds before entering my office.

*Please bring a water bottle, it will need to be left in your car.

*Please limit the number of personal items you bring into the building to the essentials - ie car keys, wallet and cell phone.

*If possible, please shower and have on clean clothes for your appointment. It is requested that you not run other errands before coming in for your appointment.

*Please wear loose, comfortable, stretchy clothes. T-shirt with leggings, yoga/workout pants, sweats or pajamas are great. No skirts or short shorts please.

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