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Visitor checkin

Authentication Verification 01/18/2022 17:58:03
Have you or anyone in your household experienced any of the following symptoms in the past 2 weeks (Fever 100.4 degrees F+, cough, shortness of breath or other symptoms associated with COVID-19)?Yes No
Have you been advised by a doctor, healthcare provider, or any public health authority to stay home or otherwise avoid contact with others?Yes No
Have you recently been in contact with anyone who has tested positive for COVID-19?Yes No
In the past 14 days, have you traveled to a restricted area that is under a Level 2, 3, or 4 Travel Advisory according to the U.S. State Department (including China, Italy, Iran, and most countries in Europe)?Yes No
In the past 14 days, have you traveled to any states outside of Wyoming?Yes No
If the previous answer is Yes, list the states you visited.
My appointment is with the following employee(s)
Authentication token

Form created 2021-10-22 13:50:11