Art of the Arch Aesthetics Pre-Appointment Questionnaire
Please complete this form in its entirety prior to each appointment
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Name (first and last) *
Appointment Date *
MM
/
DD
/
YYYY
Time of appointment *
Time
:
Have you experienced any of the following symptoms in the past 14 days? Check box if yes. *
Required
Have you been within 6 feet of a person with COVID-19 in the past 14 days? *
Have you traveled to or from any of the following states in the past 14 days by any means, including by car? *
Required
Have you traveled internationally within the past 14 days, including cruise ships? *
Have you or someone in your household tested positive for COVID-19 in the past fourteen days? *
Do you currently have pending COVID-19 test results? *
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