Covid-19 Questionnaire

Name Please enter your name

Telephone We'll never share your Telephone with anyone else.

Email address We'll never share your email with anyone else.

Do you have any of the following flu like symptoms? Fever, New dry cough, sore throat, Headache, body aches, shortness of breathe

Are you or a family member you live with in the High risk category?

Have you or anybody you have been in contact with, been tested positive for Covid-19 in the past 14 days?

Have you had a Covid-19 test and are currently awaiting results?

Have you travelled abroad in the last 14 days?