Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6 F/ 37.5 C

I am not experiencing the symptoms: fever, cough, sore throat

I have not been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I have provided is accurate and complete

Thanks for submitting!

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