Please make sure to fill in this questionnaire 48 hours before each appointment. It is extremely important to answer all questions honestly, this is important for both of our safety.
How are you feeling today?
Please answer all questions 48 hours before your appointment.
Please remember if this form is not completed I reserve the right to refuse service to anyone whom I deem not suitable for treatment or for any other reason at my own discretion.
Please remember this to ensure the safety of yourself and others.
Thanks for submitting!