COVID-19 QuestionnairePlease answer the following questions:WITHIN THE PAST 7-14 DAYS Name* First Last Have you had a fever or do you currently have a fever?*YesNoHave you experienced a recent onset of respiratory problems, such as a cough, difficulty breathing?*YesNoHave you traveled to or visited areas/neighborhoods with documented COVID-19 transmission?*YesNoHave you come in contact with a patient with confirmed COVID-19 infection?*YesNoHave you or anyone you are in close contact with recently traveled via airport or visited an airport?*YesNoIs there at least one person experiencing fever or respiratory problems having close contact with you?*YesNoHave you recently participated in any gatherings, meetings or had close contact with many unacquainted people?*YesNoSignature* Thank you for your cooperation and understanding.