Health CheckFields marked with an * are required.error_outline Some fields contain errors Show {{form.showErrors ? 'Less' : 'More'}}keyboard_arrow_down {{error.field}} - {{error.message}} NameFirst NameLast NameEmailEvent DateEvent TimeDo you currently have a fever of 100.4 degrees F or great?YesNoDo you have a cough or shortness of breath that began within the past 14 days?YesNon the past 14 days, have you received a positive result from a COVID-19 test?YesNon the past 14 days, have you been in contact with anyone testing positive for COVID 19?YesNoPaymentDiscountSubtotalTaxTotal USDSubmitThe form has been submitted.
