1. Have you have recently had any contact with anyone that is/has tested positive for COVID-19? *
2. Do you have a new or worsening cough or shortening of breath/difficulty breathing? *
3. Do you have a fever? (subjective or greater than 100 degrees F) *
4. Do you have at least two of the following: chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell or diarrhea? * *
A copy of your responses will be emailed to the address you provided.