Covidmellisa2020-10-07T10:51:23+02:00 Client Questionaire COVID-19Please fill out the below form before starting your treatment. Select the Mommy Wellness branch you are visiting---AlbertonClaremontDurbanvilleSomerset WestBahrain Full Name Telephone Number Email Address Date of Treatment Do you have fever (temperature above 38 degrees Celsius, or have you felt hot or feverish recently (14-21 days)? YesNo What is your current temperature? Do you have shortness of breath or any difficulties breathing?YesNo Do you have a cough?YesNo Any other flu-like symptoms, such as gastrointestinal upset, headache, or fatigue?YesNo Have you experienced recent loss of taste or smell? YesNo Have you been in contact with any confirmed COVID-19 positive persons?YesNo Are you over 65 years of age?YesNo Do you have heart disease, lung disease, kidney disease, diabetes, or any auto-immune disorders?YesNo Have you traveled in the past 14 days to any regions affected by COVID-19?YesNo
