Uncategorized Covid-19 Survey Posted by Evangelicalcenterph on April 16, 2020April 26, 2021 Full Name Mobile Phone Number Address Line 1 Address Line 2 E-Mail Gender Male Female Do you currently have fever reaching 38°C? Yes No Do you have a sore throat? Yes No Do you have a cough Yes No Do you have a cold? Yes No Do you find it difficult to breathe Yes No Have you been suffering from stomach pain or Diarrhea ? Yes No Have you been feeling nauseous and/or vomiting? Yes No Did you travel abroad in the past 14 days? Yes No Have you had interaction with confirmed CO-VID-19 patients? Yes No Submit Δ Share this:TwitterFacebookLike this:Like Loading... Related
Philippine Relief and Development Services Inc. 