Olympia Family Acupuncture
Denise Robison EAMP
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Pre-Treatment Appointment Check-in
Simply Submit this form when you arrive for your visit.
You will be Taken to
Our Virtual Waiting Room to
Begin
Your Session
via Telehealth (phone or video)
From your car before bringing you inside.
Appointment Check-in
CV19 Safety Procedures
PRE-TREATMENT APPOINTMENT CHECK-IN
How was your last treatment?
How was your last treatment?
Details
Have you experienced any of the following in the past 2 weeks?
FEVER or CHILLS
RESPIRATORY SYMPTOMS: Coughing, Sneezing, Sore Throat, Eye Irritation
SUDDEN FATIGUE or ACHING
SHORTNESS OF BREATH
CHESTPAIN HEADACHE JOINT PAIN
I MAY HAVE BEEN EXPOSED TO A PERSON WITH THE ABOVE SYMPTOMS
I have not been CONSISTENT PRACTICING SOCIAL DISTANCING / MASKING IN PUBLIC
I have recieved close-contact medical treatment in a facility that does not require PPE.
No. I have NOT experienced any of the above.
If you have answered yes to any of the above selections
Submit Answers / ENTER VIRTUAL WAITING ROOM
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