Health Screening Survey
I am a(n): *
What is your first and last name? *
Check if you have any of the following symptoms: *
Have you traveled internationally or outside the state of MI in the last 14 days, excluding commuting from a home location outside of MI? For purposes of this order, commuting is defined as traveling between one's home and work on a regular basis. *
Have you had any close contact in the last 14 days with someone that was diagnosed with COVID-19? *
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