Test Preps Health Screening Form

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Test Preps Health Screening Form

Please complete and submit this form PRIOR to entering the building for your SAT/ACT class.
If you answer YES to any of the questions, DO NOT come to class.
Please text 574-7349 to alert us of your absence and discuss options for a make-up class.

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* Indicates required question

Name *

Your answer

Today's Date *

MM

/

DD

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YYYY

Have you had any new or worsening symptoms associated with COVID-19 including but not limited to: fever or chills, cough, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste/smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea? *

Yes

No

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