Public COVID-19 Screening Questionnaire


Full Name: 
(Required)

Q1. Do you have any of the following symptoms?

  • Fever or chills (For the sake of uniformity, we will consider a fever a temperature of 100°F oral, tympanic, or temporal)
  • 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

Q2.Have you been tested for COVID-19 at the direction of a healthcare provider or the Department of Health and are waiting to receive the test results?