Have you had any of the following symptoms in the last 14 days
Yes
No
Headache
Sore Throat
Cough
Fever
Loss of taste or smell
Nauseau / vomiting
Diarrhea
Shortness of breath
Muscle aches
Congestion
Fatigue
Yes
No
Headache
Sore Throat
Cough
Fever
Loss of taste or smell
Nauseau / vomiting
Diarrhea
Shortness of breath
Muscle aches
Congestion
Fatigue
Contact *
Have you been in close physical contact (less than 6 ft) for more than 15 minutes with anyone who was officially confirmed with a labratory covid test?