Booking Questionnaire

All fields are required.

In the past 14 days, have you tested positive for COVID-19?


In the past 14 days, have you been in close contact with anyone who tested positive for COVID-19?


Are you currently experiencing fever, coughing, shortness of breath, the new loss of taste or smell, or any other COVID-19 symptoms?


In the past 14 days, have you had a non-COVID-19 vaccination?


In the past 90 days, have you received monoclonal antibodies or convalescent plasma for COVID-19 treatment?


Did you have a severe allergic reaction (e.g., anaphylaxis) to component of the COVID-19 vaccine or after a previous dose?


Did you have a known (diagnosed) allergy to a component of the vaccine or an immediate allergic reaction of any severity to a previous dose?