Covid-19 Disclaimer Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *PhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDid you return from a high-risk area/city/county/country/region within the last 14 days? Have you had close contact (within 6 feet for more than 10 minutes) from a person who is showing symptoms of Covid 19, or is known or suspected to have Covid 19? *YesNoDo ANY of the following symptoms currently apply to you? *Fever at or above 100.4 FShortness of breathChillsMuscle painSore throatDry, persistent coughDifficulty breathingRepeated shaking with chillsHeadacheNew loss of taste or smellNone of the aboveCheck all that apply. If you answered YES to any of the above symptoms, we cannot keep your grooming appointment. Please call us immediately and we will give you further instructions regarding your appointment. If you answered None of the above, please sign and submit this form and please arrive on time for your appointment! By my signature below, I am confirming that I have read and understood the information outlined here. I will hold harmless Peace, Paws & Harmony, Inc. from any health liability or occurrence resulting from utilizing their services, and confirm that I am free from transmissible symptoms of infectious disease to the best of my ability to determine. Should it become clear that I have symptoms within 24 hours of my visit to Peace, Paws & Harmony, Inc., I will advise the business of such immediately.Signature *Clear SignatureMessageSubmit Form