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Covid 19 Daily Wellness check
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* Indicates required question
Email
*
Your email
Last Name
*
Your answer
First Name
*
Your answer
Fever over 100.4
*
Yes
No
Cough
*
yes
No
Sore Throat
*
yes
no
Shortness of breath
*
yes
no
Contact with Covid-19
*
yes
no
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