Are you experiencing any of the following COVID-related symptoms?
- A fever of 100.4 F or higher
- Shortness of breath or difficulty breathing
- New loss of taste or smell
- Nausea, vomiting, or diarrhea
Required - Please select No or Yes
Have you tested positive for COVID in the last 10 days, or are you pending any COVID-related test results?
Required - Please select No or Yes
In the last 10 days, have you been in close contact with someone who:
- Has had a positive COVID-19 viral test (this test shows a current infection)
Required - Please select No or Yes