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COVID-19 Questionnaire

Answer the questions below to find out if you are at risk for Coronavirus (COVID19).

Do you have a fever?
Do you have a cough?
Do you have difficulty breathing or shortness of breath?
Do you have blush lips or face?
If yes to any of the previous questions, have you traveled within 14 days of symptom onset?
Are you over the age of 65?
Do you have a history of heart disease, diabetes, or lung disease?
Do you have a history of decreased immunity?

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

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