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COVID-19 Pre-Screen Questionnaire

  1. INSURANCE INFORMATION/ INFORMACION DE ASEGURANZA

  2. COVID-19 Medical Questions

  3. Have you traveled outside the City of Eagle Pass in the last 14 days? Ha viajado fuera de la cuidad de Eagle pass en los ultimos 14 dias?*

  4. Have you been in contact with someone who was confirmed to be infected with COVID-19 in the last 14 days? A tenido contacto con alguien diagnosticado con COVID-19 en los ultimos 14 dias?*

  5. Have you had any of these symptoms in the last few day? A tenido alguno de los siguientes sintomas en los ultimos dias?*

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