COVID-19 screening The Lash Shrink LLC
12 HOUR SCREENING PRIOR TO APPOINTMENT
Email address *
Name *
First and last name
Date of birth *
Phone number *
Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, felt “feverish” or had a temperature of 100.4 F or greater? *
Required
Have you had any signs or symptoms of a fever in the past 24 hours such as *
Required
Have you experienced shortness of breath? *
Have you been in contact with someone who has/ may have Covid-19 or who has been asked to self-quarantine? *
Have you been tested for COVID-19? *
Are you a healthcare provider? *
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