Symptom Questionnaire

PLEASE SUBMIT THE FOLLOWING:

Gender
Age Range
Within the last 14 days, have you experienced a new cough or shortness of breath that you cannot attribute to another health condition?
Within the last 14 days, have you experienced a new fever that you cannot attribute to another health condition?
Within the last 14 days, have you experienced a new sore throat that you cannot attribute to another health condition?
Within the last 14 days, have you experienced new muscle aches that you cannot attribute to another health condition?
Within the last 14 days, have you experienced a new loss of smell or taste that you cannot attribute to another health condition?
Have you traveled or been anywhere where you could have been exposed to COVID-19 in the last 14 days?
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