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* 1. Please enter the name used for the booking.

Please complete this short screening survey on behalf of you and anyone visiting LLT with you. If you answer yes to any of the questions, we will need to reschedule or refund your upcoming visit.

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* 2. Do you or anyone in your party have any of the following symptoms that are not caused by another condition? Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, recent loss of taste or smell, sore throat, congestion, nausea or vomiting, diarrhea

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* 3. Within the past 14 days, have you or anyone in your party had contact with anyone that you know had COVID-19 or COVID-like symptoms? Contact means being 6 feet (2 meters) or closer for more than 15 minutes with a person, or having direct contact with fluids from a person with COVID-19 (e.g. being coughed or sneezed on.)

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* 4. Have you or anyone in your party had a positive COVID-19 test for active virus within the past 10 days?

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* 5. Within the past 14 days, has a public health or medical professional told you or anyone in your party to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?

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* 6. Have you or anyone in your party had a temperature higher than 100.4 Fahrenheit within the last 48 hours?

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