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Covid Prescreen for In person appointment
Prescreening for testing, symptoms and exposure is required prior to any in-person appointment. If you currently have any cold or virus symptoms, do not come to the office.
Masks are required at all times in the office.
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* Indicates required question
Full Name
*
Your answer
Have you tested positive for Covid-19 in the past 10 days?
*
Yes
NO
Have you had close contact with someone with COVID-19 in the last 10 days? Close contact is defined as spending a total of 15 minutes or more within 6 feet of someone currently infected with COVID-19.
*
Yes
NO
Do you have any of the following symptoms? (If you are actively sick with a cold, virus or respiratory infection, please email lisa@davissquareacupuncture.com immediately; do not come to your appointment.)
*
Fever
Sore throat
Cough
Runny nose/sinus congestion
Muscle aches, body aches or chills
Loss of smell/taste
Shortness of breath
Nausea, diarrhea, vomiting or other unusual GI/Digestive symtpoms
NONE OF THE ABOVE
Required
IF YOU ANSWERED 'YES' TO ANY OF THE ABOVE QUESTIONS, please describe below and email lisa@davissquareacupuncture.com to discuss rescheduling.
Your answer
Do you agree to wear a medical or KN95 mask (no cloth masks) at all times in the office, and minimize time in the waiting room?
*
Yes
No
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