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  1. Are you waiting in a vehicle?*
  2. Are you a(n): *
  3. Reason for your visit to the Court (please select)*
  4. Self Screening
  5. Do you have a fever greater than 100.4 degrees? *
  6. Do you have any of the following symptoms: fever, cough, shortness of breath, sore throat or diarrhea?*
  7. Do you have any of the following symptoms?*
  8. Within the last 14 days, have you had contact with an individual diagnosed with COVID-19?*
  9. Have you traveled internationally in the last 14 days? *
  10. Do you have a face mask or face covering to allow entry into the building?*
  11. Temperature (Court to Process)
  12. Signature (Court to Process)
  13. _______________________
  14. _______________________
  15. Leave This Blank:

  16. This field is not part of the form submission.