Covid-19 Survey 16Apr 202021 May 2020Add a comment 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 Share this:TwitterFacebookLike this:Like Loading...
