COVID-19 Pre-Screening Questionnaire

COVID-19 Pre-Screening Questionnaire
1. Have you experienced any of the following symptoms within the last 14 days? Check all that apply. *
2. Have you been diagnosed of suspected of having COVID-19? *
3. Are any of your family members or immediate/close contacts currently sick or experiencing fever, cough, shortness of breath, or flu-like symptoms? *
4. Have any of your family members or immediate/close contacts been diagnosed with covid-19? *
5. Have you travelled to the U.S. Or internationally within the past 14 days? *
6. Have any of your family members travelled to the U.S or internationally within the past 14 days? *