Covid Screening | The Fang and Flower Tattoo and Piercing Studio

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

I have not tested positive for COVID-19 or been in contact with anyone who has tested positive for or had a suspected case COVID-19 in the last 30 days.

I am not currently experiencing, or experienced any of the following symptoms in the last 14 days: - Fever (temperature of 37.8°C or greater) - New or worsening cough - Shortness of breath - Sore throat - Difficulty swallowing - New smell or taste disorder(s) - Nausea/vomiting, diarrhea, abdominal pain - Runny nose, or nasal congestion.

I have not travelled outside of the Country or been in contact with anyone who has travelled outside the Country in the last 14 days.

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!