Clone of Clone of Form

1
Have you recently started experiencing any of these symptoms? Select all that apply.* This field is required.
Fever or Chills
Mild or Moderate difficulty breathing
New or Worsening cough
Sustained loss of smell, taste, or appetite
Sore throat
Vomiting or diarrhea
Aching throughout the body
None of the above
2
If "None of the above" is selected, you should not select any other options.
3
None Selected in multiple choice
4
Other options selected in multiple choice
Should be Empty: