Art + Science - COVID-19 Client Waiver

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* 1. What is your name?

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* 2. When is your appointment?

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* 3. Have you had a body temperature over 100 degrees Fahrenheit or have you used a fever reducer in the previous 24 hours to treat a body temperature over 100 degrees Fahrenheit?

Yes

No

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* 4. Do you have a new cough that you cannot attribute to another health condition?

Yes

No

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* 5. Do you have a new or worsening sore throat that you cannot attribute to another health condition?

Yes

No

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* 6. Have you recently developed a complete loss of smell or taste?

Yes

No