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Jax-Zen COVID-19 Screening Questionnaire
Email *
Name (First/Last) *
Phone number *
Have you had a fever in the last 24 hours of 100 degrees Fahrenheit or above? (If your answer is YES, please contact us to reschedule your appointment.) *
Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath? (If your answer is YES, please contact us to reschedule your appointment.) *
Do you now, or have you recently had, any chills. Muscle aches, new loss of taste or smell, or new rashes or lesions? (If your answer is YES, please contact us to reschedule your appointment.) *
Have you recently tested positive for an active, COVID-19 viral infection or received a positive result for a coronavirus antibody test? (If your answer is YES, please contact us to reschedule your appointment.) *
Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms? (If your answer is YES, please contact us to reschedule your appointment.) *
Important! For your safety and ours, we are requiring all guests to wear a face mask. Additionally, your temperature will be taken upon arrival. *
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