COVID-19 Screening

Name

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Current Temperature

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Have you had a fever in the last 24 hours of 100°F or above?

Do you now, or have you recently had, any respiratory or flu symptoms, cough, sore throat, shortness of breath, or GI complaints?

Have you lost your sense of taste or smell?

Do you now, or have you recently had, any chills, muscle aches or new rashes or lesions?

Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?

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Serenity Holistic Massage | 131 Court St. | Farmington ME | 04938 | 207-779-6671