Have you had a fever >100.0º in the last 14 days?* Yes No Have you had shortness of breath or difficulty breathing?* Yes No Have you had a cough?* Yes No Have you had any flu-like symptoms in the past 14 days? (nausea, vomitting, muscle aches, headach, fatigue)* Yes No Have you been exposed to anyone with COVID-19 symptoms in the last 7-10 days?* Yes No Have you recently lost taste or smell?* Yes No Are you over the age of 60?* Yes No Do you have any chronic medical conditions? (asthma, diabetes, heart conditions, auto-immune diseases, kidney problems, recent cancer treatments, etc.)* Yes No Have you traveled outside of the state in the last 14 days?* Yes No Positive 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* CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.