COVID-19 Questionnaire with Branch

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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?

Are you experiencing any difficulty in breathing?

* Start branch radio based

Please tick any one of the following symptoms that can be applies to you.

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.