SHA Visitor COVID-19 Contact Tracing Form
Please complete this form so we have your contact information in the event that we need to do contact tracing due to a COVID-19 exposure. Thank you
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Email *
Name (First/Last) *
Date of Visit *
Time
:
Date of Visit *
MM
/
DD
/
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Email Address *
Phone Number *
Name of person you are meeting with today. *
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