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Save time- complete your new client intake forms ahead of time.  

Covid-19 Health Declaration

Have you had a fever in the last 24 hours of 100°F or above?
Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
Do you now, or have you recently had, any chills, muscle aches, new loss of taste or smell, or new rashes or lesions?
Can you exercise to get your heart rate and respiratory rate up without any problem? (This would indicate whether their cardiopulmonary function is unimpaired.)
Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?
Have you had a new onset of muscle aches and pain since the emergence of the virus? (This is a possible early sign of coagulopathy, and a reason to defer treatment until you have been tested and cleared of coagulopathy risk.)
Have you seen any new marks, rashes, spots, bumps, or other lesions on your skin? (This indicates the possibility of microvascular clotting, and is reason to defer treatment until you have been tested and cleared of coagulopathy risk.)

Thanks for submitting your COVID form!

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