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Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Email
I have not had a fever over 100.4 in the past 24 hours.
I don't have any Covid-19 symptoms: fever, cough, sore throat, shortness of breath.
I haven’t been in close contact with a Covid-19 patient in the last 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete
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