


20 W 72nd St, NYC 10023
Lunch: 11:00 am -4:00 pm | Weds - Fri
Dinner: 4-10pm Sun-Weds | 4-11pm Thurs-Sat
Brunch: 11:00 am - 3:00 pm | Sat - Sun
Delivery & Pickup: 4-9pm Mon-Tues
12-9pm Weds-Fri | 11:30am-9pm Sat-Sun

Health Declaration Form
I hereby certify, represent as follows:
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Within the fourteen (14) days immediately preceding the Date of Health Declaration Form, I HAVE NOT
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Tested positive or presumptively positive with the Coronavirus or have identified as a potential carrier of the COVID-19 virus or similar communicable illness.
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Experienced any symptoms commonly associated with the Coronavirus.
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Been outside of the United States
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Been in direct contact with or the immediate vicinity of any person I knew and/or now know to be carrying the Coronavirus or have traveled outside the United States within the last 14-days.