COVID-19 Symptom Evaluation
Please take the time to answer a few questions about symptoms, travel, and contact you’ve had with others. No information will be shared with a third party.
What is your name?
Please enter your email address.
How old are you?
Have you recently started experiencing any of these symptoms? Check all that apply
Do any of these apply to you? Select all that apply
In the last 14 days, have you traveled internationally?
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In the last 14 days, have you been in an area where COVID-19 is widespread? Select all that apply
In the last 14 days, what is your exposure to others who are known to have COVID‑19?Select all that apply.
Do you work in a medical facility? This includes a hospital, emergency room, other medical setting, or long-term care facility. Select all that apply
Which state do you live in?
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