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