COVID-19 Symptom Check
I am deaf or hard of hearing. I am using this card to communicate.
I may need a certified sign language interpreter, captioning or other ways to communicate.
I have circled the best ways to communicate with you.
- Interpreter
- Text
- Writing
- Lip Read
- Gesture
- Assistive Listening Device
Quick Communication
This is my level of pain:
- No Pain
- Mild Pain
- Moderate Pain
- Severe Pain
- Very Severe Pain
- Worst Possible Pain
These are my symptoms:
- Fever
- Cough
- Shortness of Breath
- Sore Throat
- Lost Sense of Taste/Smell
- Muscle Aches
- Chills
- Headache
Other symptoms I have:
I have had symptoms this many days:
I have had close contact with someone (within 6 feet) who has COVID-19: