COVID-19 Questionnaire

COVID-19 Questionnaire

COVID-19 Questionnaire

COVID-19 Questionnaire

COVID-19 Questionnaire

Metropolitan Optical

Have you experienced a fever higher than 100.5 °F in the last 3 days?*

Have you experienced any of the following new-onset symptoms of COVID-19 in the last 10 days?

Loss of smell or taste*

Shortness of breath or difficulty breathing*

Feeling weak or lethargic*

Lightheadedness or dizziness*

Vomiting or diarrhea*

Slurred speech*

Seizures*

Have you been tested for and diagnosed with COVID-19 infection?*

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

Order Contacts
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