Appointments

Please Note:

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone at the Store. Thank you for your time.
Name*
First Last
Primary Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Self-Declaration by Visitor
Have you returned from any of the countries listed China, Italy, Iran, Korea within the last 14 days?*
- Yes
- No
Have you had close contact with or cared for someone OR Know Of Someone - diagnosed with COVID-19 within the last 14 days?*
- Yes
- No
Have you been in close contact with anyone who has traveled within the last 14 days to one of the following countries: China, Italy, Iran, South Korea?*
- Yes
- No
Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)?*
- Yes
- No
FACE MASKS ARE REQUIRED IF YOU HAVE NOT BEEN VACCINATED
Signature
Date
Any questions should be directed to USA Tube Audio 1-800-676-1085 Ext 2