All visitors are required to complete a pre-visit screening.
  • Hidden
    MM slash DD slash YYYY
    • Fever or chills
    • Cough
    • Shortness of breath
    • Muscle aches
    • Sore throat
  • (This includes a period of 15 minutes or longer while not wearing protective PPE, including a face mask)
  • Type your name below to sign this document.
  • This field is for validation purposes and should be left unchanged.