COVID-19 Lacey/longview | Greater Western Wash

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First Name

Last Name

Email

Phone

Have you experienced:

A New Fever 100.4 or higher

A New Cough

New Shortness of Breath

A New Sore Throat

New Muscle Aches

Been in Contact with a confirmed COVID-19 Patient in the last 14 days

None of the Above

Facility Location*

Class if Attending

Instructor

Time of Arrival

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Phone (360) 486-9400