By completing and signing this declaration form, you agree to the following:
I hereby declare that neither I nor anyone in my household has experienced any cold or flu-like symptoms in the last 14 days (including not limited to; fever, cough, sore throat, respiratory illness, difficulty breathing, or stomach cramps). If I or anyone in my household has experienced any cold or flu-like symptoms after submitting this declaration, I will then not come for treatment at ALRC for a minimum period of 14 days after the cold or flu-like symptoms have subsided. This declaration will remain in effect until ALRC declares that the requirements in this declaration are no longer in effect.