COVID-19 QUESTIONS

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COVID-19 QUESTIONS

Please answer the following questions

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* Indicates required question

HAVE YOU OR SOMEONE YOU KNOW BEEN DIAGNOSED WITH COVID-19? *

Yes

No

If so, are you around them?

Option 1

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ARE YOU EXPERIENCING A FEVER? *

Yes

No

Maybe

ARE YOU EXPERIENCING A COUGH? *

Yes

No

Maybe

ARE YOU EXPERIENCING SHORNTESS OF BREATH? *

Yes

No

Maybe

Submit

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