This is the Spanish page for the COVID Screening Questionnaire. Click below for other languages:
Portuguese | Mandarin | Italian | Arabic | Korean | Romanian
What is your full name?
What is your date of birth?
Answer option for these questions: Yes or No
Have you traveled outside the US in the last 30 days?
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?
Anosmia (Change in Smell)