Self Health Screening
By clicking "ACCEPT" below I acknowledge the following: I have not been diagnosed with COVID-19 nor shown symptoms of COVID-19 in the past 14 days, such as: feeling ill, having a fever of 100.4 or above, cough, experiencing shortness of breath, or losing a sense of taste or smell, and that I meet all state or local requirements to enter this facility. I also have not been in close contact with someone who has been diagnosed with or shown symptoms of COVID-19 in the past 14 days.
Don't Forget to MASK UP. *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy