Additional Recommended COVID-19 Questionnaire

Please answer the questions truthfully.

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


• 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).

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

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

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

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