Marni Matyus, LMT
Medical Massage Therapist
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972-836-7809
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COVID-19
Questionnaire
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Have you or a member of your household tested positive for COVID-19
Yes
No
Have you or anyone in yoousehold been in contact with anyone with COVID-19 or told to self quaranteen?
Yes
No
Have you or a member of your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, new loss of smell, new loss of taste, temperature at or greater than 100 degrees Fahrenheit?
Yes
No
Have you or any member of your household travled outside of the DFW area in the last 21 days?
Yes
No
Have you or a member of your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, new loss of smell, new loss of taste, temperature at or greater than 100 degrees Fahrenheit?
Yes
No
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