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COVID-19 Questionnaire (Check Appropriate Boxes to Comment Below)
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Have you been tested for COVID?
Fever Over 38 degrees
New Onset of Cough
Sore Throat
Shortness of Breath
Difficulty Breathing
Decrease or sudden loss of taste and smell
Have you had a new onset of muscle aches and pain since the emergence of the virus?
Nausea
Vomiting
Diarrhea
New rash or other skin changes
Contact with someone with COVID
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Are you in high or moderate risk groups?
Have you been shielding?
Contact with someone who is awaiting COVID test results.
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Neck
Left Side of Neck
Right Side of Neck
Upper Back
Left Side of Upper Back
Right Side of Upper Back
Mid Back
Left Side of Mid Back
Right Side of Mid Back
Low Back
Left Side of Low Back
Right Side of Low Back
Chest
Abdomen
Left Arm
Right Arm
Left Shoulder
Right Shoulder
Left Elbow
Right Elbow
Left Wrist
Right Wrist
Left Hand
Right Hand
Left Leg
Left Thigh
Left Calf
Right Leg
Right Thigh
Right Calf
Left Gluteal
Right Gluteal
Left Hip
Right Hip
Left Groin
Right Groin
Left Knee
Right Knee
Left Ankle
Right Ankle
Left Foot
Right Foot
Sacrum
Tailbone (coccyx)
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Arthritis
Broken Bone / Fracture
Dislocation
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Bruise Easily
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