COVID-19 Screening

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COVID-19 Screening

Please note, we are taking mild precautions against COVID-19 and Influenza including distancing, cleaning, and screening.

In the past 14 days *

Please select all that apply

I have been exposed to someone with COVID-19.

I have had one or more of the following symptoms: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea.

I am unvaccinated and have travelled.

None of the above

Additional details (optional):

*I attest that my responses are accurate to the best of my knowledge

Signature *

*I recognize that by typing my full name this is considered a legal document.

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