4th Avenue Cafe, COVID-19 Question Survey
First Name and Surname *
Contact Number *
Please Enter Your Temperature *
Residential Area (ie. Bryanston/Illovo) *
Have you experienced flu-like symptoms? Anything including a high fever, shortness of breath, sore throat/cough, tiredness, muscle pain, diarrhoea or any other digestive upset, loss of sense of smell or taste or any new skin conditions on toes and/or fingers. *
Have you tested positive for COVID-19 within the last 14 days? *
Have you been in contact with anyone who has tested positive for COVID-19 within the last 14 days? (Work or social) *
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