Client Self Declaration

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Are you experiencing or have you experienced any of these symptoms?

     Cough

     Shortness of Breath / Difficulty Breathing

     Chills

     Repeated Shaking with Chills

     Muscle Pain

     Headache

     Sore Throat

     Loss of  Taste or Smell

     

Have you been diagnosed with COVID 19 or have you been in contact or cared for someone that was diagnosed with COVID 19 in the last 14 days?

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Have you been in contact with someone which may have been exposed to COVID 19 in the last 14 days?

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Have you traveled outside of Ohio in the last 14 days?

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If you say no to all of the above: please use the hand sanitizer and proceed to front desk.

If you have traveled outside of Ohio in the last 14 days, please use the hand sanitizer and inform the front desk of recent travel.

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