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Have you experienced any of the following symptoms of COVID-19 within the last 14 days? Cough, sore throat, shortness of breath, muscle pain, runny nose, sneezing, loss of smell with or without fever
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Have you been in close contact or have been in isolation with a suspected or confirmed case of COVID-19 in the last 14 days?
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I, verify that the answer I provided on this form to be truthful and honest. It is my responsibility to notify the office if any of the answer changes before my appointment
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