QuickPass, Willow Valley Communities

Resident ID *

First Name *

Last Name *

Phone *

Email *

Save my details on this device

According to the U.S. Centers for Disease Control and Prevention & the World Health Organization, COVID-19 Symptoms include:

Sore throat
Congestion or runny nose
Fever or chills
Cough
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Nausea or vomiting
Diarrhea
Shortness of breath or difficulty breathing

Are you experiencing a NEW ONSET or CHANGE OF SYMPTOMS associated with COVID-19 illness, as noted above?*

YesNo

Have you been diagnosed with COVID-19 in the last 10 days?*

YesNo

In the last 10 days, have you had DIRECT CLOSE CONTACT (less than 6 feet for more than 15 minutes) with someone with a confirmed case of COVID-19?*

YesNo

I agree to go through the drive thru screening station before going to my Willow Valley destination.

I certify all the information provided is accurate to the best of my ability.

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Willow Valley Communities
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