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) *