Olympia Family Acupuncture
Denise Robison EAMP
PRE-TREATMENT REMOTE INTAKE
Cycle Day/Due Date/ Recent Onset Date
Have you experienced any of the following in the past 2 weeks?
FEVER or CHILLS
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 been to a Medical Facility or Office to recieve close-contact treatment
If you have answered yes to any of the above selections we will be meeting virtually today.
Please submit your form to begin and enter our virtual waiting room at Https://doxy.me/ofa