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COVID-19
PRESCREENING

COVID-19
PRESCREENING

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IN THE PAST WEEK HAVE YOU:
Felt generally unwell, or experienced cold or flu-like symptoms?*
- Yes
- No
Been tested for COVID-19?*
- Yes
- No
Been caring for, or in close contact with anyone experiencing the signs or symptoms of COVID-19, or other flu-like symptoms?*
- Yes
- No
Been in contact with anyone who has tested positive or is under quarantine for COVID-19?*
- Yes
- No
Been in close contact with an essential worker who feels they were exposed to COVID-19?*
- Yes
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Returned from travel internationally or from a region impacted severely by COVID-19 (e.g. NYC, Seattle)?*
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Visited a group care facility (e.g. elderly assisted living home) or prison?*
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- No
Name*
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Confirmation:*
By checking this box you consent to the following:
I confirm that my response is correct and complete to the best of my knowledge, and agree to abide by the social distancing and safety measures currently in effect in the Quantum office.

CONTACT US

Toll Free: 800.440.1088
Voice: 480.949.1088
Fax: 480.949.2427

18700 N. Hayden Rd., Suite 310
Scottsdale, AZ 85255

The Quantum Group® provides marketing, distribution, training, and support services for annuity and insurance products offered through licensed insurance carriers to financial professionals.

The Quantum Group, USA, LLC, an Arizona limited liability company. In CA, d/b/a Quantum Distribution & Insurance Services LLC. License # 0M85682. The Quantum Group, USA, LLC. is licensed in all states except Alaska and New York.

© 2026 The Quantum Group, USA, LLC.

CONNECT WITH QUANTUM

Home
Our Story
- Ron Shurts
Meet the Team
Our Services
Blog
- FAQs
Careers
Contact
Advisor Login
Socials
- Calendar
- Facebook
- LinkedIn
- Instagram
- x / twitter
- Soundcloud
- Youtube
- Phone

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