**If it has been two weeks since your second Covid Vaccine and you have no Covid symptoms, you can disregard this form. Please inform staff member when you check in.
If you answered yes to any of the questions, please do one of the following:
1. Call and reschedule your appointment
2. Call to switch your appointment to telehealth.
By submitting this form I declare all of the answers are true and I am not aware of having any risk factors for Covid-19.