COVID Screening Questionnaire (Arabic)

This is the Arabic page for the COVID Screening Questionnaire. Click below for other languages:

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What is your full name?


What is your date of birth?


Answer option for these questions: Yes or No


Travel Screening


Have you traveled outside the US in the last 30 days?


Symptom Screening


Have you had a fever or felt feverish in the past 24 hours?


Have you had contact with a known or suspected case of COVID-19?


Do you have trouble breathing or a new cough?


Are you having nausea, vomiting, or diarrhea?


Do you have a new rash?


Do you have any of the following new symptoms?


Sore throat


Muscle Aches


Severe Dizziness/Fainting


Anosmia (Change in Smell)


Chest Pain


Nasal Congestion