Please fill out this form not less than 24 hours before your appointment. If your condition changes from the time you submit this form to your therapist and before your appointment time, please re-evaluate yourself before attending the appointment
confidential client COvid-19 pre-screening form
Please take the time to fill out the information below.
Signs of a fever:
in adults: 38°C (100.4°F) and above (oral temperature),
in older adults: 37.8°C (100°F) and above (oral temperature),
in children: 38°C (100.4°F) and above
or 1.1°C above the person's usual value