Online Consent 1. Do you have a fever or have you felt feverish recent (in the 14 days)? YesNo 2. Do you have shortness of breath or difficulties breathing? YesNo 3. Do you have a cough or any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue? YesNo 4. Any personal or family history of positive COVID 19 or quarantine. YesNo 5. Any history of known case of positive COVID 19 or quarantine patient / Neighbours/ Apartment/ Society area. YesNo 6. Do you have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders? YesNo 7. Have you travelled in the past 14 days to any regions severely affected by COVID-19? YesNoYour Name : Email :
