COVID 19 DECLARATION | MRH Care

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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!

Mrh health Care

Phone: 01273 809690 / 07787861286 / 07735496571

Email: esther@mrhcare.com

© 2020 by Mrh Care Ltd

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