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Main Line Endoscopy COVID-19 Screening Survey

This question requires a valid date format of MM/DD/YYYY.
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This question requires a valid date format of MM/DD/YYYY.
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4. Location of Procedure *This question is required.
5. Have you been diagnosed with COVID-19 within the past 30 days? *This question is required.
6. Have you been in contact with someone under investigation for, or with a confirmed case of COVID-19 within the past 14 days? *This question is required.
7. Have you had symptoms of COVID-19 (fever, cough, shortness of breath, chills, muscle aches, headache, fatigue, loss of taste/smell, nausea/vomiting, diarrhea, runny nose) within the past 14 days? *This question is required.
8. Have you been tested for COVID-19 within the past 14 days? *This question is required.
9. Have you received any dose of the COVID-19 vaccine? *This question is required.