MANDATORY COVID-19 PRE-SCREENING FORM

Pre-screening Questionnaire
Have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
Are you experiencing or have you experienced any of the following in the past 14 days:
You must check and agree to all of the following prior to being approved for an appointment:
By submitting this form, you confirm that you have answered truthfully and agree to the above terms

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