Washington Institute of Dermatologic Laser Surgery
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COVID Questionnaire  (Form 1/4)

Please present a physical copy of your COVID vaccination card at check-in or attach a copy of the card to the form below.

In the past 2 weeks, have you been in contact with anyone who is confirmed COVID-positive?
Do you currently have any loss of smell or flu-like symptoms, such as fever, chills, runny nose, stomach upset, diarrhea, headache, or fatigue?
Have you received your COVID vaccine?
Have you received your COVID booster?
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