If you are experiencing any of the following please mark "YES". If you are not experiencing any of the following, please mark "NO". *I am exhibiting at least two symptoms related to COVID-19, i.e. fever, cough, sore throat, shortness of breath, chills, muscle pain, headache, diarrhea, and new loss of taste or smell. *I have been in contact with a person who has tested positive for COVID–19. *I have a fever greater than 100°. *