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Where should we send
Your results
and FREE "Top 10 things you can do to manage your health at home" guide?
FINISH QUIZ
100% Privacy. We will never spam you.
What is your gender?
Female
Male
What age group best describes you?
18 or younger
19-29
30-39
40-49
50-64
65 or older
How often are you visiting public places? (For example: concerts, events, conferences etc.)
Never
Rarely
Occasionally
Regularly
How much sleep are you averaging?
less than 6 hours
6-7 hours
7-8 hours
8-10 hours
over 10 hours
How much water are you drinking daily? (8oz cups)
0 - 2 cups
3 - 4 cups
5 - 7 cups
over 8 cups
How often do you smoke?
Never
Rarely
Socially
Regularly
How often are you washing your hands?
Never
Rarely
Occasionally
Regularly
Have you expierenced cough, runny nose, sore throat, and or fever recently?
Yes
No
Are you having difficulty breathing or shortness of breath?
Yes
No
Are you experiencing pain or pressure in your chest?
Yes
No
Have you visited China since December 2019?
Yes
No
Have you been physically close to anyone traveling from China since December 2019?
Yes
No
Not sure
Have you been recently tested for COVID-19?
Yes
No
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