top of page
Health Declaration
In light of the COVID-19 pandemic, SHIMA is taking several precautions to ensure the safety, health and general well-being of our staff and patients. At this time, the precautions include daily COVID-19 screening and questionnaire and the use of personal protective equipment. 
We understand that these precautions may feel intrusive and overwhelming, but we have determined them to be necessary to ensure we keep everyone safe during these unprecedented times.
Please disclose to us any condition that compromises your immune system and understand that we may ask you to reschedule treatment after discussing any such conditions with us.
Do you have a fever or above normal temperture?
Are you experiencing any flu symptoms? Chills, body, muscle or headaches, vomiting?
Are you having shortness of breath or any difficulty breathing?
Have you recently lost r had reduction in your sence of taste or smell?
Have you traveled by air or cruise ship in the past 14 days??
Have you been advised to self-quarantine because of exposure to someone with COVID-19?
Have you been tested for COVID-19? If yes, Have you been diagnosed with COVID-19? If yes, when?
Have you been advised to self-quarantine because of exposure to someone with COVID-19?

Thanks for submitting!

bottom of page