COVID-19 Questionnaire

1. Have you experienced any cold or flu-like symptoms in the past 14 days (to include fever, sore throat, cough, difficulty breathing)?

2. Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

3. I understand that I must attend my visit alone. I agree not to bring my significant other, children, or any other individuals with me inside the suite.