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What is your email? / ¿Cuál es tu dirección de correo electrónico? / 您的电子邮件地址是什么? *
What is your first name?Nombre名 *
What is your last name?Apellido姓 *
In the last 2 weeks, have you been around anyone with or suspected to have Covid 19? Do you have new cough, sore throat, runny nose, fever, headache, loss of taste/smell, diarrhea, or shortness of breath?/En las últimas 2 semanas, ¿ha estado cerca de alguien con o sospecha de tener Covid 19? ¿Tiene tos nueva, dolor de garganta, secreción nasal, fiebre, dolor de cabeza, pérdida del gusto / olfato, diarrea o dificultad para respirar?/在过去的两周中,您和周围有人或怀疑有Covid 19 (新冠) 的人在一起吗?您是否有新的咳嗽,喉咙痛,流鼻涕,发烧,头痛,味觉/气味下降,腹泻或呼吸急促? *
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