Symptom Check Have you or anyone in your household experienced any of the following symptoms in the last 21 days?Fever over 100°F Yes No Cough Yes No Chills Yes No Sore throat Yes No Body aches Yes No Shortness of breath Yes No Loss of smell or taste Yes No Lifestyle QuestionsHave you or anyone in your household been tested for COVID-19? Yes, and I am awaiting test results Yes, and I have received the results No Have you or anyone in your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the last 30 days? Yes No Have you or anyone in your household traveled within or outside of the U.S. in the last 21 days? Yes No Have you or anyone in your household traveled on a cruise ship in the last 21 days? Yes No Are you or anyone in your household a health care provider or emergency responder? Yes No Have you or anyone in your household cared for an individual who is in quarantine or has tested positive for COVID-19 in the last 21 days? Yes No Have you been in close proximity to any individual who tested positive for COVID-19 in the last 21 days? Yes No Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19? Yes No I agree that I have answered all of the above questions to the best of my knowledge. I agree that I have answered all of the above questions to the best of my knowledge.
