Covid-19 Questionnaire

Your First Name (required)

Your Last Name (required)

Your Email (required)

1. Have you or any of your family (household) experienced any symptoms of Covid-19?

2. Have you or any of your family (household) tested positive for Covid-19 in the last 14 days?

3. Have you traveled out of the country or to any Covid-19 hot spots in the last 14 days?

4. Do you or any of your family (household) have pending Covid-19 test results?

If you have answered yes to any of these questions, we ask that you please reschedule your appointment, for the safety of our team members and our guests.

5. Do you need to reschedule your appointment?