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Have you had a temperature greater than 100 in the last 2 weeks? *

Have you had any of the following symptoms within the last 2 weeks?

Cough *

Shortness of breath or difficulty breathing *

Sore throat *

New loss of taste or smell *

Have you had a positive COVID-19 test within the last two weeks? *

Have you had contact with anyone who has been diagnosed with COVID-19 within the last two (2) weeks? *

Have you traveled via airplane domestically within the last two (2) weeks? *

Have you traveled via airplane internationally within the last two (2) weeks? *