Covid-19 DIne in Customer Form | DJERDAN BUREK

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The Burek Factory

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Covid-19 Health Declaration DINE IN FORM

How are you feeling today?

First Name

Last Name

Address

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Phone

Select a date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!