Have you had a fever >100.0º in the last 14 days?*YesNoHave you had shortness of breath or difficulty breathing?*YesNoHave you had a cough?*YesNoHave you had any flu-like symptoms in the past 14 days? (nausea, vomitting, muscle aches, headach, fatigue)*YesNoHave you been exposed to anyone with COVID-19 symptoms in the last 7-10 days?*YesNoHave you recently lost taste or smell?*YesNoAre you over the age of 60?*YesNoDo you have any chronic medical conditions? (asthma, diabetes, heart conditions, auto-immune diseases, kidney problems, recent cancer treatments, etc.)*YesNoHave you traveled outside of the state in the last 14 days?*YesNoPositive responses to any of these questions might require us to reschedule your appointment. For more information about COVID-19 (including testing sites), please see: https://health.utah.gov.Name*CAPTCHAEmailThis field is for validation purposes and should be left unchanged.