THUNDERBIRD TATTOO L.L.C.

COVID-19 QUESTIONNAIRE

Greetings Thunderbird Tattoo patron,

Thank you for your patience during this mandated time away from each other. We are all looking forward to getting back to our regular schedule!

Our operation will be a bit different to keep us all healthy and protect our loved ones. In compliance with the new requirements that are in addition to our regularly stringent sanitation protocols, we ask that prior to your appointment you complete this pre-appointment screening form before your appointment.

Have you had a persistent cough in the last week?

Have you had a fever in the last two weeks?

If you answered YES to either of the above, were you tested for COVID-19? When? If it was within the last 14 days, what were the results of the test?

Have you been in close contact with anyone with these symptoms, or anyone who has been diagnosed with COVID-19 in the past 14 days?

If you answered YES to any of these questions, we are required to reschedule your appointment to a later date that will be determined when your symptoms (cough, fever, and shortness of breath) have been resolved, and your fever has been resolved without medication for at least 72 hours, OR at least 14 days after contact with a person that has been sick with a cough, fever, or diagnosed COVID-19.

According to the Phase One Reopening Guidelines, we are required to record your contact information, date, and time of your appointment as well as your tattoo artist's information.

If there is positive COVID-19 case associated with Thunderbird Tattoo, Public Health Services may need us to provide this information for a contact tracing investigation. Unless otherwise required, this information will be held confidential and will be destroyed after 60 days from the appointment.

Full Name

Today's Date

Initials

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!