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Online Ordering

Health Declaration

Please fill out the following health declaration form in order to dine on site. Submissions will be held for a minimum of 28 days per government orders.

First Name

Last Name

Code

Phone

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

Are you experiencing any flu like symptoms?

No

Yes

Date

Time

I confirm that the information given in this form is true

Thanks for submitting!

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