Do you have a fever or have you felt hot or feverish in the last 14 days?
Are you experiencing shortness of breath or other difficulties breathing?
(other than asthma)
Do you have a dry cough?
(other than normal seasonal allergies)
Have you experienced recent loss of taste or smell?
Do you have any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?
Are you in contact with any confirmed COVID-19 positive patients?
By signing this document, I acknowledge that the answers I have provided above are true and accurate.