COVID-19 Consent and Screening Form

Covid-19 Screening Form

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  • - Fever above 100.4 degrees
    - Fatigue and body aches
    - Shortness of breath
    - Nausea/vomiting
    - Cough
    - Runny nose
    - Sore Throat
    - Loss of taste or smell
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  • Date Format: MM slash DD slash YYYY