In the past 14 days have you or a member of your household tested positive for, or had a confirmed case of COVID-19?

Are you experiencing any COVID-19 or flu-like symptoms such as: Fever, chills, shortness of breath/difficulty breathing, new loss of taste or smell, cough, headache, sore throat, vomiting, diarrhea, runny nose, or muscle or body aches?
*Check “No” if the nature of the symptom (duration, intensity, etc.) is consistent with a pre-existing condition of which you are already aware (i.e., seasonal allergies, asthma, sinus headache).

Are you or any member of your household under active quarantine due to COVID-19 exposure?

In the past 14 days, have you been in physical contact with anyone who has a confirmed case of, or has been exposed to COVID-19?

Have you traveled internationally within the last 14 days?