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Tuscola County
COVID-19 Health Screening
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Email
*
Your email
Name
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Your answer
Phone Number
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Your answer
Are you fully vaccinated for Covid-19 as follows: At Least 2 weeks have passed since you have received the second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or a single-dose vaccine, such as Johnson & Johnson's Janssen vaccine.
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Yes, I am Vaccinated.
No, I am not Vaccinated.
Do you currently have, or have you had in the past 7 days , any of the following symptoms (not due to an underlying condition or illness): Fever, sweats/chills, persistent cough, shortness of breath, sore throat, loss of smell/taste, or diarrhea?
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Yes
No
Have you had any close contact in the last 14 days with someone with a positive diagnosis or presumed positive diagnosis of Covid-19?
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Yes
No
Have you been screened by any medical provider for any of the above symptoms in the last 24 hours?
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Yes
No
*
I certify I am the person named above and that the information that I have provided is accurate.
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A copy of your responses will be emailed to the address you provided.
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