Sunday Service Pre-Screening Form
Please fill out this form and click submit.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Do you have a cough or other flu-like symptoms (gastrointestinal discomfort, headache, fatigue)?
*
Please select all that apply.
No
Yes
Have you had a fever in the last 14 to 21 days?
*
Please select all that apply.
No
Yes
Have you been around someone who tested positive for COVID-19 in the past 14 days?
*
Please select all that apply.
No
Yes
Do you have shortness of breath?
*
Please select all that apply.
No
Yes
Have you experienced a recent loss of taste or smell?
*
Please select all that apply.
No
Yes
Have you traveled to a region affected by COVID-19 in the past 14 days?
*
Please select all that apply.
No
Yes
Submit
Description
Please fill out this form and click submit.
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