Mayan Moon Healing COVID-19 Screening
This is required prior to your appointment.
Email *
First and Last Name *
Phone Number *
Have you experienced any of the following symptoms within the past 2-14 days? *
Required
Have you ever tested positive for COVID-19? *
Within the last two weeks, have you been in close contact with anyone that was infected, suspected or diagnosed with COVID-19? *
Have you traveled to another city or country within the last 2 weeks? *
I agree to notify Mayan Moon Healing immediately at (847) 868-0528 of any changes to the above prior to my appointment. *
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