PLEASE COMPLETE COVID-19 QUESTIONNAIRE BEFORE YOUR NEXT SCHEDULED APPOINTMENT
HAVE YOU RECENTLY BEEN IN CONTACT WITH ANYONE WHO HAS TESTED POSITIVE FOR Covid-19? If YES, please STOP HERE.
I understand that I have the responsibility to immediately notify Hawaii health and my professional service provider should my responses on the questionnaire change.
** If unable to electronically submit , please print, complete and email to email@example.com ot you may call 808-357-3504.
AVIELLA ALOHA BEAUTY
HAVE YOU RECENTLY TRAVELED TO A RESTRICTED AREA THAT IS UNDER A LEVEL 2, 3, or 4 Travel Advisory according to the U.S. State Department? Including: China, Italy, Iran and most countries in Europe.
In the last 14 days have you traveled outside your normal, daily routine?
Do you have new or worsening onset of any of the following symptoms: fever, cough, shortness of breath, runny nose, sore throat, chills, body aches, fatique, headache, loss of taste/smell, eye drainage, congestion?
ALOHA...WELCOME TO MAUI, HAWAII
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