Please not that this is version II of the health screen form. Questions are now Yes/No. If you answer yes to any of the questions you may not practice. 1 Current Health Screen Questions 2 Complete First Name Last Name Parent First Parent Last Parent Email Parent Phone Phone Service Provider Phone Service Provider - Select -VerizonAT&TSprintT-MobilOther… Enter other… Fever (≥ 100.4°F) - Select -YesNo Cough or shortness of breath - Select -YesNo Chills - Select -YesNo Sore Throat - Select -YesNo Muscle aches or rigors - Select -YesNo Headache - Select -YesNo New loss of taste or smell - Select -YesNo Abdominal pain, nausea, vomiting or diarrhea - Select -YesNo Have had close contact with someone who is currently sick - Select -YesNo Been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19 - Select -YesNo Traveled or had close contact with anyone who has traveled internationally in the last 14 days - Select -YesNo What was your temperature reading before practice? What code is in the image? Enter the characters shown in the image. Get new captcha! What code is in the image? Enter the characters shown in the image.