Health Screening Your Name* First Last Estimated time of arrival*Estimated time of departureIn the past 24 hours, have you experienced subjective fever?*Have you felt feverish or have fever like symptoms?---YesNoIn the past 24 hours, have you experienced a new or worsening cough?*---YesNoIn the past 24 hours, have you experienced shortness of breath?*---YesNoIn the past 24 hours, have you experienced diarrhea?*---YesNoCurrent temperature?*If your temperature is 100.4°F or higher, please self-isolate at home and contact your primary care physician’s office for direction.In the past 14 days, have you had close contact with an individual diagnosed with COVD-19?*---YesNoIn the past 14 days, have you traveled via airplane internationally or domestically?*---YesNoAnything else you'd like us to know?