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Covid 19 Screening Form
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Email
*
Your email
Name & Surname
*
Your answer
Are you over 60 years of age?
*
Your answer
Have you been in contact with someone that tested positive for Covid in the past 14 days?
*
Yes
No
Do you have any of the following symptoms?
*
Fever
Shortness of breath
Chills or repeated shaking
Do you have any muscle pains or body aches?
Headaches or sore throat?
Nausea and or vomiting?
Loss of taste or smell?
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