Kay Pham-Nguyen - COVID ACKNOWLEDGEMENT FORM

Responses to this form remain confidential. Form response required for the safety of you, others around you, and photographers/assistants.

Name *

Phone Number *

Shoot Date *

Do you have cold or flu like symptoms, such as fever, chills, muscle pain, or sore throat? *

Do you have a NEW onset of cough or shortness of breath? *

Have you had close contact with someone who has been diagnosed with COVID-19 within the past 14 days? *

Do you have a NEW onset of loss of taste and/or smell? *

Has it been less than 10 days since your symptoms began? *

Please acknowledge that if you have answered yes to any of these questions, you MUST call/text or email ASAP. No fee will be charged for a reschedule if necessary. *

ANY SYMPTOMS NOT LISTED IN THE QUESTIONS ABOVE? *

Submit

Thank you!