Sign up here




1. Are you feeling sick today?


2. In the past 14 days have you had contact with a confirmed COVID-19 patient?


3. Have you ever had a positive test for COVID-19 or has a doctor told you that you have COVID-19?


4. Have you received passive antibody therapy or convalescent plasma as a treatment for COVID-19 in the last 90 days?


5. Are you immunocompromised? (taking medication or being treated for cancer, leukemia, HIV/AIDS or other immune system problems or taking medication that affects your immune system)


5a. Do you have a heart disease?


5b. Do you have diabetes? (Type I or Type II)


5c. Do you have a chronic kidney disease?


5d. Do you have a chronic lung disease? (Asthma, COPD, Emphysema)


5e. Do you have a neurologic disease? (Alzheimer's, Amyotrophic Lateral Sclerosis, Bell's Palsy, Epilepsy/Seizures, etc.)


6. Do you have High Blood Pressure


7. Have you ever received a dose of COVID-19 vaccine?


8. Do you have any current issues with your weight?