Health & WELLness Checks

For the health and safety of our community, we will be conducting short Health & WELLness Checks with all participants who attend an in-person gathering. Please fill out the form below and send any questions to marisa@meetyouatthewell.org. Thank you for your cooperation as we work to make in-person programming fun and safe for everyone!

Name

First Name

Last Name

Phone

(###)

###

####

Which program did you attend?

Has anyone in your household become sick or exhibited symptoms such as fever or chills, a cough, shortness of breath, fatigue or body aches, or a new loss of taste or smell since you attended the Well program listed above?

No - we are all still healthy!

Yes - someone has become sick.

If yes, has this person been tested for COVID-19? Please share any relevant details, such as why they will or will not be tested, diagnosis results if you have them, etc. A Well team member will follow up if necessary.

In the case of a positive COVID-19 diagnosis in one of our participants, the other individuals who attended the same event will be notified. To respect your privacy, no names or personal information will be shared.

Is there any feedback (positive or constructive) you'd like to provide about the safety efforts at this event? This can include things like social distancing guidelines, communications prior to the event, protocols around eating and drinking, mask usage, etc.