FUBC Contact Trace & Wellness Check
This information will not be publicly shared. This will only be used to contact you if we have encountered a COVID related health emergency
First and Last Name *
Phone number *
Email
Have you had any of these symptoms that are not caused by another condition? Fever , Cough, Shortness of breath or difficulty breathing , Fatigue, Muscle or body aches, Headache, recent loss of taste or smell, Sore throat, Congestion, Nausea or Vomiting, Diarrhea *
If yes to the above question please select which symptoms you have been experiencing.
Clear selection
Within the last 14 days, have you been in close contact with anyone that you know had COVID-19 or COVID like symptoms? *
Have you had to quarantine due to a positive COVID test or being in contact with someone who has tested positive for COVID *
Have you had to quarantine due to a positive COVID test or being in contact with someone who has tested positive for COVID *
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