Storybook Villa Wellness Survey

Storybook Villa Wellness Survey

*all adults must submit this survey. Minimum 1 survey per family. If you have children under your care, your answers include their health status as well. If you are staying with another family, it is your responsibility to forward this Wellness Survey (url link) to the other adult guests you are staying with. This Wellness Survey link is also posted on our website at Storybookvilla.com/coronavirus.
*the goal of this survey is to keep you safe. We not only want to keep Storybook Villa a germ-free environment, but we also aim to provide you with peace-of-mind that previous guests have confirmed their health status. (If you answer "Yes" to any questions below, please explain in the Comments box at the bottom).
Name *

First Name Last Name
Name

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Do you have a cough? *

Yes No
Do you have a fever now or have you in the past 14-21 days? *

Yes No
Have you come in contact with a confirmed COVID-19 positive patient in the last 14 days? *

Yes No
Are you experiencing shortness of breath or difficulty breathing? *

Yes No
Are you experiencing other flu-like symptoms such as headache or fatigue? *

Yes No
Have you experienced recent loss of taste or smell? *

Yes No
Have you traveled in the last 14 days to any regions affected by COVID-19? *

Yes No
Comments: If you answered Yes to any questions, please explain using these boxes.

Optional: leave any necessary comments here *
Please Note: Prior to check-in, if due to illness any answers change on the survey, for any guests, the adult(s) must contact Storybook Villa immediately to disclose. We can be reached at 714-334-3736 and info@storybookvilla.com
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