Pre-Class Symptom Check

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form during the check-in process.

PLEASE BE HONEST!
Your answers do not preclude you from participating in class today (unless you have tested positive for COVID-19 in the past two weeks, of course).

For the first question below, use the email address associated with your WellnessLiving account.

Name

Please check all of the following that you have experienced in the last 48 hours. (EVEN IF YOU THINK THEY ARE DUE TO ALLERGIES, EXERCISE, ETC.) *

Fatigue

Headache

Sore / raspy throat

Sneezing / Runny Nose / Congestion

Body / muscle aches

Coughing

Shortness of breath or difficulty breathing

New loss of taste or smell

Fever or chills

Nausea, vomiting, or diarrhea

Persistent pain or pressure in the chest

I solemnly swear that I haven't experienced any of these symptoms in the past 48 hours.

Other:

Required

In the last 2 weeks, have you: *

Tested positive for COVID-19

Been exposed (for any period of time) to someone who might have had COVID-19

Been exposed (for any period of time) to someone with confirmed COVID-19

None of the above

Required

If you've been exposed to someone with presumed or confirmed COVID-19 in the past 2 weeks, what day was the most recent day of exposure?

YYYY

Have you tested for COVID-19 in the past week? If so, what was the result? (choose all that apply) *

Took a rapid antigen test & results were NEGATIVE

Took a rapid antigen test & results were POSITIVE

Took a PCR test & results were NEGATIVE

Took a PCR test & results were POSITIVE

Took a PCR test & waiting for results

Have not tested in the past 7 days

Other:

Required

I understand that I am required to let Fit & Fearless know if I test positive for COVID-19 within 12 hours of getting those test results OR if I cannot access a test, but suspect that I may have COVID-19. *

I agree

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms