COVID Pre-screening Questionnaire to be completed prior to your appointment. First Name* Last Name* Email* Date/Time of my appointment*12:00 AM01:00 PM02:00 PMAre you double vaccinated?*Please SelectYesNoIndicate if you have had any of the following signs or symptoms, in the last 14 days: Fever*Please SelectNoYesBody aches*Please SelectYesNoAbdominal pain*Please SelectYesNoFeeling tired and unwell*Please SelectYesNoCough*Please SelectYesNoBreathlessness*Please SelectYesNoRunny nose*Please SelectYesNoSore throat*Please SelectYesNoLoss of smell*Please SelectYesNoDiarrhea*Please SelectYesNoRed eyes*Please SelectYesNoSkin rash or discolouration of fingers or toes*Please SelectYesNoDo you suffer from seasonal allergies e.g. hayfever?*Please SelectYesNoDo you have any contacts with known COVID symptoms?*Please SelectYesNoAre you a contact for COVID?*Please SelectYesNoHave you been tested for COVID in the last 48 hours?*Please SelectYesNoHave you been required to self-isolate in the last 14 days?*Please SelectYesNoHave you visited a location of interest in the last 14 days?*Please SelectYesNoDo you have any contacts who have been tested for COVID in the last 14 days?*Please SelectYesNoHave you had COVID?*Please SelectYesNoHave you travelled out of Auckland in the last 14 days (including overseas travel)?*Please SelectYesNoHave you been in MIQ or any form of isolation in the last 14 days?*Please SelectYesNoUnderstand* I understand I must attend my appointment alone (no support people or children allowed during Level 3). I also understand that I should wait in my car until 5 minutes prior to my appointment and will scan in using the displayed QR code.* Declare* I declare the above to be true and I fully understand that there is a very small chance, despite all possible precautions being taken by Kate Allen, that I could be exposed to or contract COVID by attending this appointment. I give permission to Kate Allen, to give my details to the appropriate authorities should this be required for contact tracing. Δ kateallen.co.nz Dermal filler in the under eye area is an advanced My happy place! ๐ซถ๐โ๏ธ Not a day goes by t I love advanced skincare options like skin needlin Another work in progress but I think we are coming Load More Follow on Instagram