Below you will find LIFESTYLE EXPOSURE QUESTIONS that we require all clients to respond to prior to scheduling an appointment with our office.
It is important to us to keep our clients safe during this time of the Covid-19 pandemic. However, we also need to stay safe so we are not putting ourselves in the position of being overly exposed (which is for our benefit and our clients’ benefit), so please look over these questions and let me know your responses:
(1) Do you regularly and WILLINGLY wear a mask and social distance when you are around others (who do not live in your household) in public? __ yes __ no
(2) Do you have anyone living in your home who has a compromised immune system? __ yes __ no
(3) What states have you traveled to in the last month? ____________________________
(4) Are you a FIRST RESPONDER (ambulance worker, nurse or doctor caring for Covid-19 patients, police officer, etc.)? __ yes __ no
(5) Are you an essential worker who works around other workers who have tested positive for Covid-19 (Amazon, Nestle, Walmart, grocery stores, etc.)? __ yes __ no
(6) Are you over the age of 65? __ yes __ no
(7) Do you have a compromised immune system?
(8) Do you work for or own an indoor bar or indoor restaurant? __ yes __ no
(9) Have you experienced any symptoms of Covid-19 including cough, shortness of breath, difficulty breathing, chills, fever, or loss of taste or smell?
(10) Have you been to an indoor bar,, indoor restaurant, or indoor party (with more than 10 people) where you and others were not wearing a mask or social distancing in the last month? ___ yes ___ no
(11) Have you exercised in an indoor gym in the last month where you and others are not wearing a mask or social distancing? ___ yes ___ no
Your responses will not necessarily result in being denied service. We have the option to use a higher level of protective equipment or a different mask so your responses simply help us to adjust.
**The easiest way to respond to these is to text Donna at 216-339-3401 and simply list the number and your response. Only takes a few minutes. Your cooperation is very much appreciated.