Skip to main content
Referral Btn
Please attest that you have not experienced one or more of the following symptoms in the last 24 hours (not related to chronic, known conditions or seasonal allergies):
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
I attest that I have not experienced one or more of the listed symptoms in the last 24 hours.
  • Reset signature Signature locked. Reset to sign again
  • MM slash DD slash YYYY
Close Menu