Beacon Pilates COVID-19 Screening
To be filled out by all Visitors, before entering the building.
First and last name *
Phone Number *
Which studio are you at today? *
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19? *
Have you tested positive for COVID-19 in the past 14 days? *
Have you experienced any symptoms of COVID-19 in the past 14 days? *
Symptoms of Coronavirus
THE TERM “SYMPTOMATIC” INCLUDES ANYONE WHO HAS THE FOLLOWING SYMPTOMS OR COMBINATIONS OF SYMPTOMS:
Fever
Cough
Shortness Of Breath

OR AT LEAST TWO OF THE FOLLOWING SYMPTOMS:
Fever
Chills
Repeated Shaking With Chills
Muscle Pain
Headache
Sore Throat
New Loss Of Taste Or Smell
Do you have any of the symptoms listed above? *
Have you traveled within a state with significant community spread of COVID-19, for longer than 24 hours, within the past 14 days. *
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