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Are you experiencing fever or chills?
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Are you experiencing new or unusual muscle aches?
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Are you experiencing any new cough or shortness of breath?
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Are you experiencing new or unusual sore throat, nasal congestion or headache?
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Are you experiencing unusual and new fatigue?
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Are you experiencing new or unusual nausea, vomiting or diarrhea?
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Are you experiencing new or unusual loss of smell or taste?
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Have you traveled outside of NC within the past two weeks? If so, did you use commercial plane, train or bus?
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By printing my name below, I acknowledge that I am treating patients for Stillpoint Acupuncture, LLC and to my knowledge have not been exposed within the past 14 days to any persons known to have COVID19. I am feeling well today. If at anytime today or in the future, I begin to experience any of the aforementioned symptoms, or if I discover I have been exposed to someone who tested positive for the novel coronavirus, I will notify Melissa Peet and will seek a replacement for my shift.
Please enter your name below if you agree with the above statement.
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