Covid 19 Questionnaire Form

Do you currently have any flu like symptoms (i.e cough, runny nose, fever, sore throat) or shortness of breath? *
Have you been unwell in the last 14 days? *
Have you been overseas in the past 14 days? *
Are you in close contact or living with any persons who have either recently come back from overseas or have been ill in the last 14 days? *
Have you been in close contact with a person with confirmed COVID19 in the last 14 days? (skip the next 3 questions if you selected No) *
Have you been tested for COVID19?
If you have been tested for COVID19, do you have the results?
If you have received the results, is it: