BIAV COVID-19 Questions

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* 1. Name

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* 2. In the past 48 hours have you had:
a. Any cough, shortness of breath, difficulty breathing, or new loss of taste/smell?
b. Fever of 100.4 or higher, chills, or body aches?
c. Headache, sore throat, GI symptoms (e.g. nausea/vomiting/diarrhea), or runny nose/congestion?
d. Have you had a positive COVID-19 test in the last 10 days?
e. Are you waiting on a COVID-19 test result for reasons other than pre- procedure/surgery?

Yes

No

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* 3. Have you been exposed to anyone with COVID-19 in the last 14 days?

Yes

No

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* 4. Have you traveled internationally or been on a cruise in the last 14 days?

Yes

No

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* 5. Have you traveled to Arizona or Florida in the last 14 days?

Yes

No