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Do you have a fever greater than 100.4? YesNo
Do you have difficulty breathing or shortness of breath? YesNo
Have you traveled internationally (in the last 14 days)? YesNo
Do you have persistent pain or pressure in the chest? YesNo
Any mental changes such as confusion or inability to arouse? YesNo
Any blue hues of your lips or face? YesNo
Have you been around anyone diagnosed with Corona virus? YesNo
Dr Bragg will review all assessments and email you back. Thank you for participating in FVC/Svelte first Tele-medicine assessment!
