COVID-19 Screening Questionnaire

I have a high fever of greater than 102°F, OR I have a high fever that has lasted longer than 48 hours.

I can t speak in full sentences or do simple activities without feeling short of breath.

I am having severe coughing spells, or I am coughing up blood.

My lips or face are blue.

I have severe and constant pain or pressure in my chest.

I feel very tired or lethargic.

I feel dizzy, lightheaded, or too weak to stand.

I am having slurred speech or seizures.

I do not feel like I can stay at home because I feel seriously ill.

I have a fever between 100.4°F and 102°F, am feeling feverish, or feel warm to the touch.

I am having flu-like symptoms (chills, runny or stuffy nose, whole body aches, a headache, and/or feeling tired).

I have new loss of taste or smell.

I have a new or worsening cough.

I have a new or worsening sore throat.

I am having shortness of breath that is not limiting my ability to speak.

Please describe the option that best describes your symptoms: