Please answer the following questions:
1. Do you currently (or in the past 14 days) have any of the following?
Fever (100.4° F [38° C] or greater using an oral thermometer)
Shortness of breath (not severe)
Repeated shaking with chills
New loss of taste or smell
2. Have you traveled outside the United State in the last 14 days?
3. Have you had any contact with anyone with COVID-19 in the last 14 days?
4. Are you caring for someone or living with someone who is ill or at high risk for COVID-19?
Please verify that you are human
Should be Empty: