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Covid-19 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, Chills,Sore Throat, Shortness of breath or difficulty breathing, New cough, New loss of taste or smell, New rashes or lesions, Nausea or vomiting and Diarrhea
I haven’t been in close contact with a Covid-19 patient in the last 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete
Submit
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