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Please select the one that best describes you. You DO NOT need to be experiencing all of the symptoms listed in any one category to select it.

Severe Symptoms: I have a fever of 102 or higher or I have a fever that has lasted longer than 48 hours. I can’t speak in full sentences or do simple activities without feeling short of breath. I am having severe coughing spells, or I am coughing up blood. My lips or face are blue. I have severe and consistent pain or pressure in my chest. I feel very tired or lethargic. I feel dizzy, lightheaded, or too weak to stand. I’m having slurred speech or seizures. I do not feel like I can stay at home because I’m feeling seriously ill.
Mild symptoms: I have a fever between 100.4 Fahrenheit and 102 Fahrenheit, I’m feeling feverish or I feel warm to the touch. I have a new or worsening cough. I have a new or worsening sore throat. I’m having flu like symptoms chills, runny nose, stuffed up head, headaches, body aches and/or feeling tired. I am having shortness of breath that is not limiting my ability to speak. I have a new loss of taste or smell.
No symptoms: I am not having any symptoms

EXPOSED: Yes I have been in close proximity to someone who has been diagnosed with our presumed to have COVID-19 (By proximity we mean within 6 feet of the person for a prolonged period of time or being coughed on).
CLOSE CONTACT: Yes I live or work in a place where people reside meet or gather in close proximity to. This includes nursing homes or other long-term care facilities, healthcare settings, office buildings, workplaces or prisons.
UNEXPOSED: No, I have not been exposed
I do not know

I am 65 years of age or older
I have chronic conditions such as diabetes, hypertension, kidney disease, on dialysis, liver disease or lung disease
I have been told by my doctor that I am very overweight or obese
I am pregnant
I have a neurological condition that affects my ability to cough
I regularly use tobacco or nicotine products
I have a condition that weakens my immune system or makes it harder to fight infections. Example AIDS, cancer, lupus, rheumatoid arthritis, bone marrow transplant or solid organ transplant
I am taking medications that can effect my immune system. Example steroids, chemotherapy, biologics
None of the above