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Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
I am not experiencing the symptoms: fever, cough, sore throat
I haven’t been in close contact with a Covid-19 patient in the last 14 days
I haven’t tested positive for COVID-19 in the past 14 days
I have not traveled within a state with significant community spread of COVID-19 for longer than 24hrs within the past 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete
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