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Temperature Check Form
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Email
Your answer
Phone Number
Your answer
Have you traveled out of town in the last 3 weeks?
Yes
No
Have you came in contact with anyone that was positive for COVID?
Yes
No
Have you had a temperature of over 100 degrees.
Yes
No
What is your temperature?
Your answer
What is todays date?
MM
/
DD
/
YYYY
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