Covid Waiver In the past 14 days:Have you had a cough?* Yes No Have you had a fever?* Yes No Are you quarantined because of travel?* Yes No Are you living with anyone who sick or quarantined?* Yes No Consent* I understand that if I have checked yes to any of these questions, services cannot be provided and I will have to reschedule my appointment.Name* First Last CAPTCHA 41267
