COVID-19 Questionnaire Home COVID-19 Questionnaire Required Questionnaire Please fill out the questionnaire below before we confirm your studio session. COVID-19 Visitor Questionnaire The safety of our employees, interns, customers, families, and visitors remains Studio 411's priority. As the Coronavirus Disease 2019 (COVID-19) outbreak continues to evolve and spreads globally, we are monitoring the situation closely and will periodically update company guidance based on current recommendations from the Centers for Disease Control and Prevention and the World Health Organization. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our staff and clients, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building. Thank you for your cooperation.First and Last Name*Phone Number*Have you had close contact with or cared for someone diagnosed with COVID-19?* Yes No Have you worked in facilities or locations with recognized COVID-19 cases?* Yes No Have you experienced any cold or flu-like symptoms in the last 14 days?* Yes No Have you experienced either of these symptoms in the last 14 days?*Select all which apply. Cough Shortness of Breath Fever Repeated Shaking with Chills Headache New Loss of Taste or Smell Diarrhea Chills Muscle Pain Sore Throat Vomiting None of the above Consent* I have answered these questions truthfully.E-Signature*Please type your name below First Last Today's Date* MM slash DD slash YYYY
