Have you come into contact with anyone in the past 14 days that has tested positive for Covid-19? *
In the past 24 hours, have you had any of the following new or worsening symptoms: COUGH, SHORTNESS OF BREATH OR DIFFICULTY BREATHING, FEVER, SORE THROAT, DIARRHEA, LOSS OF SENSE OF SMELL OR TASTE? *
Копие от отговорите ви ще бъде изпратено до посочения от вас имейл адрес.
Изпращане
Изчистване на формуляра
Никога не предоставяйте пароли чрез Google Формуляри.