BC Waza COVID-19 Pre-Practice Questionnaire
Before attending practice, please fill out this form.
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Date *
MM
/
DD
/
YYYY
First Name *
Last Name *
Age Group *
I have tested positive for COVID-19 in the past 14 days *
I have experienced symptoms of COVID-19 in the past 14 days *
I’ve returned from a ‘high infection rate’ state in the past 14 days *
I've had close contact with someone who tested positive in the past 14 days *
I've had close contact with someone who's had symptoms in the past 14 days *
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