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COVID-19
PRESCREENING
COVID-19
PRESCREENING
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This field is for validation purposes and should be left unchanged.
IN THE PAST WEEK HAVE YOU:
Felt generally unwell, or experienced cold or flu-like symptoms?
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Yes
No
Been tested for COVID-19?
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Yes
No
Been caring for, or in close contact with anyone experiencing the signs or symptoms of COVID-19, or other flu-like symptoms?
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Yes
No
Been in contact with anyone who has tested positive or is under quarantine for COVID-19?
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Yes
No
Been in close contact with an essential worker who feels they were exposed to COVID-19?
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Yes
No
Returned from travel internationally or from a region impacted severely by COVID-19 (e.g. NYC, Seattle)?
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Yes
No
Visited a group care facility (e.g. elderly assisted living home) or prison?
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Yes
No
Name
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Last
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Confirmation:
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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.
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Home
Our Story
Ron Shurts
Meet the Team
Our Services
Integrated Business Development
Insurance Solutions
Strategic Marketing & Client Aquisition
Streamlined Operations & Technology
Advanced Planning & Portfolio Solutions
Additional Resources
Blog
FAQs
Careers
Contact
Advisor Login
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