COVID-19 Questionaire

PLEASE MARK ALL THAT APPLY:

1. Have you experienced in the past 14 days any COVID-19 symptoms or have been in close proximity to anyone who has tested positive for COVID-19? (e.g. fever, chills, cough, shortness of breath, sore throat, any other flu-like symptoms, diarrhea, loss of taste or smell, etc.)

 _____Yes     _____No

2. Have you been tested for Covid-19 and are awaiting your test results?

 _____Yes     _____No

3. If you marked yes for #2, have you received a negative test result for COVID-19?

 _____Yes     _____No