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Dr.  Mirian Boyd Organ’s Women’s Day Spa

                   COVID – 19 Policy


COVID 19 Certification:


By signing this document, I certify that I am aware of risks posed by COVID 19 to myself and others, especially in public settings. Therefore, I will do the following while in this clinic: wash my hands maximize, social distancing, when possible (6ft or greater), limit unnecessary travel throughout the clinic, direct nonessential accompanying personnel outside if possible, and follow guidance in clinic’s posted signage. Furthermore, I certify that I do not knowingly carry COVID-19 and I am not currently experiencing any of the following symptoms:

shortness of breath, cough, fever, runny nose, recent loss of taste or sense of smell, and/or a sore throat. If I do have these symptoms, I should contact the office and reschedule the appointment.


Name (Print)__________________________________



( Sign in the office)


 IF YOU ANSWER YEST TO ANY OF THESE QUESTIONS--                                     STOP

        Do you have a fever or do you feel feverish?

        Do you have a cough or shortness of breath?

        Do you have a sore throat?

        Do you have a loss of taste or smell?

        Have you been around anyone else with these                          symptoms in the last 14 days?

        Are you living with anyone who is sick with COVID-19?


If you have COVID-19 symptoms, please stay home and contact your healthcare provider.

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