Thank you for planning a visit to Nuffer, Smith, Tucker. In an effort to reduce the risk of COVID-19 exposure to our team, we are currently limiting visitors to individuals who are fully vaccinated. If any potential visitors are unvaccinated or answer yes to any of the questions below, our team will be happy to accommodate a virtual meeting. Please complete the following form at least 24 hours prior to your arrival at our offices, and please inform your NST contact should you need to meet virtually as an alternative.

Date of visit: *

Date

Time

Visitor's name: *

First

Last

Visitor's phone number: *

Person visiting: *

First

Last

Have you been vaccinated for COVID-19? *

• Yes
• No

Self-Declaration by Visitor

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *

• Yes
• No

Have you experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problems)? *

• Yes
• No

All information will be kept confidential and only shared with Mary Correia-Moreno, EVP of Operations and Partner.

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