How many COVID-19 vaccine dose have you received?
Including yourself, how many people in your household do not ALWAYS practice masking or social distancing outside the home?
Have you had a positive COVID-19 test within the last 10 days?
Have you had any vaccination within the last 14 days?
Have you ever had anaphylaxis (life-threatening allergic reaction)?
Have you had any of the following symptoms within the last 7 days
Do you have any of the following conditions: