Medical Questionnaire

Please fill out the following form to help us understand your physical condition.

In the past 2 weeks have you had a new onset of fever, cough, shortness of breath, sore throat, chills, muscle aches, or loss of taste or smell?
In the past 2 weeks have you had a new or worsening runny nose, nasal congestion, headache, or nausea/vomiting/diarrhea that is not related to a chronic condition or seasonal allergies?
Have you been tested for COVID-19 in the past 2 weeks?
Have you been asked to quarantine or been exposed to a person who has is confirmed positive for COVID-19 in the past 2 weeks?
ANSWER NO IF YOU PRACTICE ALL OF THE FOLLOWING; Wear a face cover, Wash your hands, Keep a safe distance?