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COVID19 Check-In Process for Return to Manna Treatment
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1.
Please enter your name and date of birth
(Required.)
Full Name
Date of Birth (MM/DD/YYYY)
*
2.
Have you tested positive for the coronavirus?
(Required.)
Yes
No
*
3.
Have you been exposed to the coronavirus?
(Required.)
Yes
No
*
4.
Have you had any of the following symptoms in the past two weeks: diarrhea, loss of smell, temperature over 99.5, coughing or shortness of breath?
(Required.)
Yes
No
*
5.
Have you been in direct contact with someone who has been outside of the country within the past 2 weeks?
(Required.)
Yes
No
6.
Have you been at a gathering of more than 50 people within the past week?
Yes
No
please specify when and where
7.
Please record your ear temperature here:
8.
Is your temperature over 99.5 degrees?
Yes
No