Covid Screening Questionnaire

COVID-19 Health Screening Questionnaire

Please encourage everyone at your table to fill out this form.
Filling out this form will also enter you into the draw for the door prize.

Currently I am not experiencing:

A fever or above normal temperature?
Shortness of breath or trouble breathing?
A dry cough?
A runny nose?
Lost or had a reduction in your sense of smell?
A sore throat?
Been tested for COVID-19 and are awaiting results?

*This field is required. *This is not a valid name. *This field is required. *This is not a valid email. *This field is required. *This is not a valid phone.

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COVID-19 Health Screening Questionnaire

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