Dedicated Doulas for Life's Journeys

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!

All material on this website is provided for informational or educational purposes only,

and is not intended as a substitute for the advice provided by your healthcare professional or physician.