Have you been diagnosed or tested positive with COVID-19 in the past 10 days? *
Have you been in close contact (within 6 feet) with someone diagnosed with COVID-19 in the past 10 days? *
Have you experienced COVID-19 related symptoms in the past 10 days (e.g. persistent cough, fever in excess of 100.4 degrees, new loss of smell or taste, shortness of breath, nausea or vomiting, etc.) *