COVID 19 DECLARATION | adielhealthcare.com

top of page

Adiel Healthcare Logo_edited_edited.jpg

HOME
ABOUT US
OUR SERVICES
APPLICATION
JOBS
TIME SHEETS / MILEAGE
COVID 19 DECLARATION
PRIVACY POLICY
CONTACT
More

Use tab to navigate through the menu items.

Woman Getting Tested

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

© 2021 by Adiel Care

bottom of page