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Home » COVID-19 Patient Safe Entry Form

COVID-19 Patient Safe Entry Form

  • Maison Optique Vision Center has put protocols in place for the safety of our patients and staff. Please sign below confirming that you have notexperienced any of the following:
    1. Fever within the past 48 hours.
    2. Symptoms of Fatigue, Muscle aches or Respiratory Distress in the past week.
    3. Exposure to anyone that tested positive for COVID-19 in the past 2 weeks.
  • Date Format: MM slash DD slash YYYY