Christ Temple Apostolic Faith Assembly COVID-19 Wellness Survey
Please enter a valid phone number.
Have you been exposed to someone who has been diagnosed with COVID-19 in the last 14 days?
Have you recently experienced a new cough?
Are you experiencing any of the following symptoms? Please check the appropriate box.
Loss of taste or smell
Shortness of breath
Have you received your Covid-19 vaccine? (optional)
To prevent the spread of the Covid-19 Virus and to help protect others, I agree to follow the Christ Temple Apostolic Faith Assembly Guidelines as given by the Medical Staff. I will take responsibility for my answers and old Christ Temple Apostolic Faith Assembly harmless.
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