Gethsemane "GST STRONG"
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Type your whole name *
Temperature *
Have you or anyone in your household been tested positive for COVID-19 in the last 14 days? *
Have you or anyone in your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit? *
Have you or anyone in your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the past 30 days? *
Have you or anyone in your household traveled in the U.S. in the past 21 days? *
Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19 *
Have you or anyone in your household cared for an individual who is in quarantine or is a presumptive positive or has tested positive for COVID-19? *
To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19? *
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