COVID-19 Questionaire Name* First Last Email PhoneDo you currently have COVID-19?* Yes NO Have you had COVID-19 in the past?* Yes No If yes, have you tested negative or had antibody test done? Yes No Have you had contact with anyone confirmed with Covid-19 in the last 14 days?* Yes No Have you had any of the following symptoms in the last 14 days? Select All Fever greater than 100 Degrees Difficulty breathing Cough Loss of sense of smell/taste PhoneThis field is for validation purposes and should be left unchanged.
