PRE-SCREEN QUESTIONNAIRE

Pre-Screen Confirmation

All information will be kept confidential and deleted after 14 days

Are you experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, head ache, sore throat, or new loss of taste or smell
Do you believe you have been exposed to someone with a suspected and/or confirmed case of COVID-19?

Thanks for submitting!