CLIENT HEALTH SCREENING CHECKLIST​

Please answer “Yes” or “No” to each question. Do you have:

​

 Fever (100.4°F or higher), or feeling feverish?

 Chills?
 A new cough?

 Shortness of breath?

 A new sore throat?

 New muscle aches?

 New headache?

 New loss of smell or taste?

 

If you have any of the following symptoms, that you can not attribute to another health condition,
please reschedule your appointment to a later date.

- Thank you.