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COVID-19 * Treatment Consent Form *

By submitting this form, you agree to have treatments during the pandemic.
Do you have any of these symptoms? Cough, High Fever, Shortness of Breath, Muscle Pain, Body Ache, Nausea, Loss of Taste/Smell?
Within the last 14 days, have you been in contact with anyone that has had COVID-19 symptoms or has been infected?
Are you living with anyone that is infected or is quarantined due to COVID-19?
Did you have any adverse efects from the Covid-19 Vaccine?

Thanks for submitting!

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