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COVID-19 Patient Screening Form

Do you have a fever or do you think your temperature is above 100.4°F?*
Are you experiencing shortness of breath or having trouble breathing?*
Do you have a dry cough?*
Do you have a runny nose?*
Have you recently lost or had a reduction in your sense of smell or taste?*
Do you have a sore throat?*
Are you experiencing chills or repeated shaking?*
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