Temporary Covid-19 Pre-Session Questionnaire
Discretion is respected and expected. Any information shared is strictly confidential.
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Do you currently, or have you in the previous 30 days, had any symptoms of a cold or flu?
- Do you currently, or have you in the previous 30 days, had any unusual physical symptoms of any kind? If so, what?
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Do you currently, or have you in the previous 30 days, had a decreased ability to taste or smell?
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Have you tested positive for Covid-19 at any time? If so, provide the date.
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When was the last time you travelled outside of the United States?
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When was the last time you were on an airplane?
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Have you been going in to work, or working remotely?
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If working remotely, for how long?
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Have you been self-quarantining alone? If not, how many people are in your household?
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If not alone, have any members of your household left the United States, travelled on an airplane, displayed symptoms of a cold/flu in the previous 30 days, or tested positive for Covid-19 at any time?
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Are there any children in your household that attend daycare or school in person?
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Have you been taking special precautions to limit exposure to Covid-19? Please explain.
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Have you, in the last 30 days, spent time inside of a restaurant, bar, or other enclosed, public space? Explain.
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Have you, to your knowledge, been in direct contact with anyone who has tested positive for Covid-19 in the last 30 days?
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If I see you for a session, are you willing to have your temperature checked?
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If I see you for a session, are you comfortable with one or both of us wearing a mask, at my discretion?
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If I see you for a session, do you understand that my tribute has temporarily increased ($350) because of the associated risk and to accommodate special precautions that I must take?
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If I see you for a session, are you willing to be tested for Covid-19 3 days prior to the session? I can provide information on free, drive-through testing options.