CORONAVIRUS Questionnaire without Branch

Help yourself in decision-making whether to seek professional medical advice or not.

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Have you traveled to any one of the destinations below in the last 21 days?

Have you recently been in contact with a person with Coronavirus?

Do you have fever higher than 100.3° F?

Do you have a runny nose?

Are you experiencing muscle aches, weakness, or lightheadedness?

Are you having diarrhea, stomach pain, vomiting?

Please fill with your personal data

Thank your for your time

We will contat you shorly at the following email address and if necessary take measures.