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Covid-19 Health Declaration &

Contact Tracing

Please complete this form upon entry of Aagh. The information provided below will be utilized to contact you in case of possible exposure to a confirmed positive COVID case.

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 have NOT 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

CONTACT US

6423 Frederick Rd, Suite D

Catonsville, MD 21228

(Turn onto Maple Drive - Lounge is located in back)

(410) 840 - 2244

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