Covid-19 Daily Questionnaire
Email *
Name: *
Date: *
MM
/
DD
/
YYYY
Do you have a new onset of cough or shortness of breath? *
Have you had a fever or felt chills? *
Do you have a headache? *
Have you experienced loss of taste or smell? *
Have you had a know exposure to a Covid-19 positive individual? *
Have you had a sore throat? *
Have you had any general muscle soreness or fatigue? *
A copy of your responses will be emailed to the address you provided.
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