Have you experienced any of the following symptoms of COVID-19 within the last 48 hours? Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea
Yes
No


Have you tested positive for COVID-19 in the past 10 days?
Yes
No


Are you currently awaiting results from a COVID-19 test?
Yes
No


Have you been diagnosed with COVID-19 by a licensed healthcare provider (for example, a doctor, nurse, pharmacist, or other) in the past 10 days?
Yes
No


Have you been told that you are suspected to have COVID-19 by a licensed healthcare provider in the past 10 days?
Yes
No