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COVID-19 Disclaimer

I agree that by creating this appointment I am confirming the following: 

  • Have not had symptoms of COVID-19 within the last 14 days including:
    • Fever
    • Cough
    • Shortness of breath or difficulty breathing
    • Chills
    • Repeated shaking with chills
    • Muscle pain
    • Headache
    • Sore throat
    • New loss of taste or smell
  • Have had no known contact with anyone testing positive for COVID-19 within the past 14 days (this includes all healthcare workers participating in the care of COVID-19 patients)
    • Have not been confirmed (via COVID-19 RT-PCR) to have been infected with COVID-19, subsequently recovered.
  • Have complied with the following social distancing guidelines for the last 14 days:
    • Staying at least 6 feet away from others during shopping at the grocery store or pharmacy
    • Avoiding “large and small gatherings in private places and public spaces, such a friend’s house, parks, restaurants, shops, or any other place”
    • Work from home when possible