Please choose the option that best describes your symptoms

None

Mild

Severe

Exposed or Sick Contact

Yes, I have been in close proximity* to someone who has been diagnosed with or presumed to have COVID-19

*within 6 ft. of the person for a prolonged period of time or being coughed on

Testing Recommended

Yes, I have been in close proximity* to someone who has been diagnosed with or presumed to have COVID-19

*within 6 ft. of the person for a prolonged period of time or being coughed on

Congregate Setting

Yes, I live or work in a place where people reside, meet, or gather in close proximity.*

*Includes nursing homes or other long term care facilities, healthcare settings, office buildings, workplaces, schools, group homes, homeless shelters, prisons, and detention centers.

Unexposed

 No, I have not been exposed.