Covid-19 Test

Name

Email

Age

What is your current role?

Select current role Student Full Time Job Part Time Job Prefer not to say Other

Have you been exposed to Covid-19 in the last 7 days?

Yes No Not sure

What is your health condition?

Select an option Excellent Good Meh Bad Dead

Do you have any of the following symptoms? (Check all that apply)

Most common symptoms:

fever dry cough tiredness

Less common symptoms:

aches and pains sore throat diarrhoea conjunctivitis headache loss of taste or smell a rash on skin, or discolouration of fingers or toes

Serious symptoms:

difficulty breathing or shortness of breath chest pain or pressure loss of speech or movement

Any other informations?

Test