* You are not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, headache, sore throat, or new loss of taste or smell.

* You have not traveled internationally within the last 14 days.

* You have not traveled to a highly impacted area within the United States of America in the last 14 days.

*You do not believe you have been exposed to someone with a suspected and/or confirmed case of COVID-19.

* You have not been diagnosed with Covid-19 and not yet cleared as non contagious by state or local public health authorities.

* You have been following all CDC recommended guidelines as much as possible and are limiting your exposure to COVID-19.

* You understand that if you do not show up to your appointment, without letting us know before hand, you will be charged in full. If you cancel with less than a 24 hour notice, you will be charged 50%. If you cancel due to COVID-19 without a 24 notice, you will be charge 50% and that will be applied to your appointment that you reschedule within the next 2 months. If you do not show up for your appointment without letting us know, you will be charged in full.

I confirm