Do you need a COVID-19 screening survey to re-open your doors?

Take ours to sign up today

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Please review and complete the form below.

First Name

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Last Name

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Phone Number

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Email Address

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Have you experienced any COVID-19 symptoms in the past 14 days?
Fever (temperature of 100°F or above) or chills, body aches, cough, shortness of breath, sore throat, nasal congestion, nausea, vomiting, diarrhea, loss of taste and/or smell. Please answer 'yes' only if you are experiencing a new onset of symptoms OR you are experiencing a change in symptoms from your own baseline if you have preexisting medical conditions (e.g. allergies, asthma)

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Have you tested positive for COVID-19 in the past 14 days?

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Have you been in close contact with a confirmed or suspected COVID-19 case in the past 14 days?

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Please confirm your not a robot.

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