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Covid Pre Appointment Questionnaire

Covid Pre-Appointment Questionnaire

This is a comprehensive health questionnaire to be filled out by your customers to schedule an appointment during the pandemic period.

Page 1

Personal Information

Email*

Full Name*

Phone Number*

Date of Birth*

Select date

Gender*

Address*

City*

State*

Zip Code*

Description:Fill out this Covid Pre-Appointment Questionnaire to schedule an appointment during the pandemic period. This comprehensive health questionnaire will help us ensure the safety of our staff and customers.

Protecting the health and safety of our staff and customers is our top priority. To schedule an appointment during the pandemic period, we require all customers to fill out this Covid Pre-Appointment Questionnaire. This comprehensive health questionnaire covers a range of topics related to Covid-19, including recent travel history, exposure to individuals with Covid-19, and current symptoms. By filling out this questionnaire, you will help us ensure that our staff and customers remain safe and healthy. We appreciate your cooperation and understanding during these challenging times.

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