Holy Cross COVID-19 Care Survey
This form is for members of Holy Cross Lutheran Church. This is for everyone at Holy Cross. There are sections on what you might NEED in the days and weeks ahead, and also how you might HELP in the days and weeks ahead. God bless you and thank you for helping us!
Email address *
Member Name
Your answer
Best Way to Contact You
Primary Phone Number
Your answer
What Are Your Needs?
Are You Receiving Holy Cross Emails?
Is Your House Warm Enough or Cool Enough?
Do you have any symptoms, such as fever, dry cough, difficulty breathing, fatigue?
Can you take your own temperature?
Are you in contact with your family?
Does your family live locally and help you?
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