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Treatment Prescreen Form
Have you tested positive for COVID-19 or been in contact with someone who has in the past 14 days?
Please select
No
Yes
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Have you been tested for COVID-19 and are currently awaiting the test results?
Please select
No
Yes
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Do you have any of the following symptoms: fever, dry cough, loss of taste and or smell?
Please select
Yes
No
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