Health Check

Please Complete the Health Form

Please email us with any questions or concerns.

Do you show any of the following symptoms? (temperature above 100, fever or chills, fatigue, nausea or vomiting, shortness of breath, cough, sore throat, congestion or runny nose, muscle or body ache, headache, diarrhea, new loss of taste or smell?)

Yes

No

Have you knowingly been exposed to someone with COVID-19, in the last 14 days?

Yes

No

Trinity Healing & Wellness Center, Inc.

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