Thank You

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