Covid Questionnaire | Mysite

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Phone

I am not sick with a cold/flu and am not displaying any signs of Covid-19 and/or flu-like symptoms

I have not returned from outside the country (including Canada/ USA) in the past 14 days

In the past 14 days, at work or elsewhere, I have not been in close contact with someone who has a probable or confirmed case of COVID-19

I have 2 Valid doses of Covid Vaccine

Approximate Time

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Hours:

Mon: *CLOSED*

Tues-Thur: 12pm-11pm

Fri & Sat : 12pm-12am
Sun: 12pm-10pm

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