Solace New York COVID-19 Health Screening
This screening form must be filled out by every individual entering the facility each time they enter the facility. It is strongly recommended you fill this form out on your own before arriving to prevent any delays and to avoid congestion at the front desk.
Email address *
First Name *
Last Name *
Phone Number *
Address *
Screening Questions
If you answer YES to any of the below questions, you will NOT be allowed to enter the Solace New York facility.
Have you experienced any COVID-19 symptoms in the past 14 days? Symptoms include but are not limited to: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle/body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea. *
Have you received a positive COVID-19 diagnostic test in the past 14 days? *
Have you had close contact with a confirmed or suspected COVID-19 case in the past 14 days? *
Have you traveled within a state with significant community spread of COVID-19 for longer than 24 hours within the past 14 days? (https://coronavirus.health.ny.gov/covid-19-travel-advisory) *
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