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Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Phone
My body temperature is lower than 100°F/ 38°C
I am not experiencing: fever, cough, sore throat or diarrhea
I haven’t been in close contact with a Covid-19 patient in the last 14 days
I am not currently required to be in quarantine
Date
I declare that the info I’ve provided is accurate & complete
Submit
Thanks for submitting!
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