Covid-19 Questionnaire

At Channell Wellness & Aesthetics, it’s our mission to make sure our valued patients look and feel their very best. To ensure the safety of everyone who walks through our doors, we ask that you please take a moment to fill out this brief questionnaire.

    Have you experienced any of the following symptoms of COVID-19 within the last 48 hours?

    Have you tested positive for COVID-19 in the past 10 days?* Are you currently awaiting results from a COVID-19 test?* Have you been diagnosed with COVID-19 by a licensed healthcare provider (for example, a doctor, nurse, pharmacist, or other) in the past 10 days?* Have you been told that you are suspected to have COVID-19 by a licensed healthcare provider in the past 10 days?*
    * Required