In the past 14 days, have you had contact with anyone known to test positive for Coronavirus, COVID-19?

Are you a healthcare worker who has been within 6 feet of a patient suspected of COVID-19 infection or have an occupation where you are in close contact with large numbers of people each day? (example: Health care Facility, Retail Store, Public Transit, Food Industry or Airports)

Do you live with, or frequently interact with people who are older than 60 years of age or who have chronic medical conditions such as cancer, heart disease, COPD, asthma, or immune disorders?

Are you experiencing fever?

Are you experiencing cough?

Are you experiencing shortness of breath?

Are you experiencing loss of smell?

Are you experiencing headache?

Are you experiencing diaria?

Are you experiencing loss of taste?

Are you experiencing sore muscles?

Do you have diabetes?

Do you have hypertension?

Do you have cardiovascular disease?

Do you have any respiratory issues?