Please reply to question on next step to see if you qualify covid-19 Quiz

Email

Name

Phone

Name of reference

Are you between 18 and 55 years old?

Yes

No

Have you tested positive for COVID-19 within the last 4 days?

Yes

No

Do you have symptoms of COVID-19 (e.g. cough, fever, loss of taste and smell)?

Yes

No

Do you have severe shortness of breath, tightening of your chest or difficulty breathing?

Yes

No

Are you willing to have nasal drops administered?

Yes

No

Are you willing to provide blood and urine samples?

Yes

No

Time is Up!

Time’s up