The Amy Gail Buchman Preschool Parent Questionnaire Health Survey - Questionnaire Question Title * 1. Child/Children's Name Question Title * 2. Date/Time Date / Time Date Time AM/PM - AM PM Question Title * 3. Has your child/children had a fever of 100.4 or higher in the last 24 hours? Yes No Question Title * 4. Has your child/children or anyone in your household had a respiratory infection, cough, shortness of breath, low-grade fever, experienced GI distress, diarrhea or vomiting? Yes No Question Title * 5. In the previous 14 days, has your child or anyone in hour household had contact with someone with a confirmed diagnosis of COVID19, is under investigation for COVID19; or is ill with a respiratory illness? Yes No Question Title * 6. Your name: Thank you for completing this survey. Submit