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SUM1 HEALTH QUESTIONNAIRE

YES or NO
I am experiencing one or more of the following symptoms;
Fever or chills, Cough, Shortness of breath or difficulty breathing,
Fatigue, Muscle or body aches, Headache, New loss of taste or smell,
Sore throat, Congestion or runny nose, Nausea, Vomiting, Diarrhea

YES or NO
Within the last 14 days, I have traveled to a hot spot as listed by the City of Chicago
https://www.chicago.gov/city/en/sites/covid-19/home/emergency-travel-order.html

YES or NO
Within the last 14 days, I have traveled outside the United States.

YES or NO
Within the last 14 days, I have been near persons who have tested positive for the SARS-CoV-2 virus or have exhibited any of the symptoms above.

YES or NO
Within the last 14 days, someone in my residence and/or workplace has exhibited one or more of the symptoms above or has traveled to a Chicago designated hotspot or has been in close contact with someone who has exhibited such symptoms or has tested positive for the SARS-CoV-2 virus.

If you answered YES to any of the statements above, please contact us at
shawn@sum1.com or 312-654-4444 to reschedule your session.


IN-PERSON RECORDING PROTOCOL