Start Questionnaire below to know your risk
About You
1. Select your age group
10-20
20-40
40-60
60-75
75-above
2. Do you smoke or have smoked for more than 20 years?
Yes
No
About Your medical disease
3. Do you have COPD, Emphysema or chronic lung disease?
Yes
No
4. Do you have heart disease or Congestive heart failure?
Yes
No
5. Do you have chronic kidney disease, kidney failure or liver failure?
Yes
No
6. Do you have Systemic Lupus Erythematosus, immune deficiency, on Immune suppression medication or transplant organ recipient?
Yes
No
7. Do you have Diabetes & Hypertension?
Yes
No
About Your Corona Virus exposure (Select one best answer)
1. Have you come in contact with any one or anyone suspected to have Corona virus Infection or COVID19 Virus?
Yes
No
2. Did you travel to China or Europe recently or traveled through any major airport hub during transit or cruise ship?
Yes
No
About Your Flu Symptoms (Select one best answer)
Select one of the sentence best describe your flu symptoms
1. Do you have a Fever with a cough?
Yes
No
2. Do you have a fever, cough shortness of breath and/or problem breathing?
Yes
No
3. Do you have a fever, cough, problem breathing, sweating, persisting chest pain or chest tightness?
Yes
No
4. Do you have a fever , cough with any confusion or a fever that keeps you awake?
Yes
No
5. Do you have a fever ,coughing with yellow skin or Jaundice?
Yes
No
6. Have you noticed a fever, cough and decrease in urine output?
Yes
No