COVID QUESTIONNAIRE
Email address *
First and last name *
Fever of 100.4°F within the last 14 days *
Are you experiencing any of these symptoms: cough, shortness of breath, respiratory infection, or sore throat, loss of sense of taste or smell. *
Have you had contact with anyone who has lab-confirmed Novel Coronavirus within 14 days of symptom onset? *
I verify that the above information is true. *
Temp *
Submit
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