COVID-19 Question Form

1) Was your temparture taken before your visit?

2) Have you taken any medication in the past 24 hours treating a fever or any other illness?

3) Are you exhibiting ANY symptoms relating to COVID-19? (new cough that is getting worse, difficulty breathing, nausea, vomiting, diarrhea, sudden loss of smell or taste without nasal congestion)

4) Is any household member in self-isolation following travel or exhibiting any COVID-19 symptoms?

5) Has public health required you or any member of you family to self-isolate or to pay attention to symptoms?