Additional Recommended COVID-19 Questionnaire

Please answer the questions truthfully.

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 Regardless of your vaccination status, have
you experienced any of the symptoms?

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• Fever or Chills
• 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 Have you been in close physical contact in the last 10 days with anyone          who is known to have COVID-19?

 

IMPORTANT: ANSWER “YES” EVEN IF YOU BELIEVE THE SYMPTOM(S) IS BECAUSE OF SOME OTHER MEDICAL CONDITION (FOR EXAMPLE, ANSWER “YES” IF YOU HAVE A RUNNY NOSE BECAUSE OF ALLERGIES).

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If you have answered yes to any of these questions, further investigation of infection is recommended.

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Utilizing a PCR test is recommended for verification of possible infection.

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or contact your health care provided for PCR testing nearest to you

We do not warrant, endorse, guarantee, or assume responsibility for the accuracy or reliability of any information offered by third-party websites linked through the site or any website or feature linked in any banner or other advertising. We will not be a party to or in any way be responsible for monitoring any transaction between you and third-party providers of products or services.

Seek medical attention if the test detects a loss of olfactory function. The absence of an abnormal test does not rule out that you have a disease or other conditions. Consult a healthcare professional, if you have symptoms of concern. The results do not consist of medical diagnosis and are not in place of a medical test of any kind.

TM

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