Have you experienced any of the following symptoms of COVID-19 within the last 48 hours? (Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea)(Required)
Have you tested positive for COVID-19 in the past 10 days?(Required)
Have you been in close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?(Required)
By signing this form, I certify all information is true and correct.
In the event staff is alerted that a visitor tests positive, we will let you know via email for your own safety.