COVID-19 Screening Questionnaire

    Have you tested positive for COVID-19 or are you awaiting results for a COVID-19 test?

    In the past 14 days, have you been in contact with anyone that has tested positive for COVID-19?

    Are you experiencing shortness of breath or any other breathing difficulties?

    Do you, or have you recently had a fever, cough, or sore throat?

    Have you experienced recent loss of taste, smell, or any other symptoms not normal to you?

    Even if you do not currently have any of the above symptoms, have you experienced any of them in the last 14 days?

    Do you have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?

    Are you in direct contact with any elderly or systemically fragile individuals?

    Do you currently have a fever?