COVID-19 QuestionnaireCOVID-19 Questionnaire COVID-19 Health QuestionnaireVaccination Status: Fully Vaccinated Partially Vaccinated Not VaccinatedHave you had any fever, cough, or shortness of breath within the last 140 days? * No YesHave you had a test for Coronavirus in the last two weeks? * No Yes: The results were negative Yes: The results were positiveHave you had any recent changes in your health? * No Yes (describe below) Describe any changes in your health First Name * Last Name * Date * Submit