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Home / Quizzes & Surveys

Archives: Quizzes & Surveys

COVID-19 SELF ASSESSMENT

Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days?
Were you exposed to someone who tested positive for COVID-19?

True exposure is defined as:

– Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period

AND

– The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing).

Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms?

 

Low-Risk: General Symptoms (2 or more)

– Fever (≥100.4°F)
– Congestion/Runny Nose
– Nausea/Vomiting/Diarrhea
– Sore Throat
– Headache
– Fatigue/Muscle or Body Aches

High-Risk: Red Flag Symptoms (1 or more)

– Cough (new onset affecting quality of life)
– Difficulty Breathing
– Loss of Taste/Smell

 
Submit your assessment now.
Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms?*

 

Low-Risk: General Symptoms (2 or more)

– Fever (≥100.4°F)
– Congestion/Runny Nose
– Nausea/Vomiting/Diarrhea
– Sore Throat
– Headache
– Fatigue/Muscle or Body Aches

High-Risk: Red Flag Symptoms (1 or more)

– Cough (new onset affecting quality of life)
– Difficulty Breathing
– Loss of Taste/Smell

 
Are you fully vaccinated?
You are considered fully vaccinated if you have been boosted or completed a primary series of Pfizer or Moderna vaccines within the last 6 months. You are also considered fully vaccinated if you been boosted or have received the primary vaccine of  Johnson & Johnson within the last 2 months.
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Time is Up!

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Time's up

Self Assessment

This COVID-19 Self-Assessment does not replace professional medical advice, but can guide you on quarantining and isolation guidelines. Parents should help answer for children. Each member of the family can take this Self-Assessment to determine their specific quarantine/isolation guidelines. You may retake this self-evaluation at anytime during your quarantine if circumstances change.

Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days?
Were you exposed to someone who tested positive for COVID-19?

True exposure is defined as:

– Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period

AND

– The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing).

Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms?

 

Low-Risk: General Symptoms (2 or more)

– Fever (≥100.4°F)
– Congestion/Runny Nose
– Nausea/Vomiting/Diarrhea
– Sore Throat
– Headache
– Fatigue/Muscle or Body Aches

High-Risk: Red Flag Symptoms (1 or more)

– Cough (new onset affecting quality of life)
– Difficulty Breathing
– Loss of Taste/Smell

 
Are you fully vaccinated?
You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine.
clock.png

Time is Up!

clock.png

Time's up

Covid Assessment

 

Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days?

True exposure is defined as:

– Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period

AND

– The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing).

Were you exposed to someone who tested positive for COVID-19?

True exposure is defined as:

– Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period

AND

– The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing).

Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms?

 

Low-Risk: General Symptoms (2 or more)

– Fever (≥100.4°F)
– Congestion/Runny Nose
– Nausea/Vomiting/Diarrhea
– Sore Throat
– Headache
– Fatigue/Muscle or Body Aches

High-Risk: Red Flag Symptoms (1 or more)

– Cough (new onset affecting quality of life)
– Difficulty Breathing
– Loss of Taste/Smell

 
Are you fully vaccinated?
You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine.
clock.png

Time is Up!

clock.png

Time's up

Covid19 Self Assessment

This COVID-19 Self-Assessment does not replace professional medical advice, but can guide you on quarantining and isolation guidelines. Parents should help answer for children. Each member of the family can take this Self-Assessment to determine their specific quarantine/isolation guidelines. You may retake this self-evaluation at anytime during your quarantine if circumstances change.

Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days?
Were you exposed to someone who tested positive for COVID-19?

True exposure is defined as:

– Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period

AND

– The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing).

Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms?

 

Low-Risk: General Symptoms (2 or more)

– Fever (≥100.4°F)
– Congestion/Runny Nose
– Nausea/Vomiting/Diarrhea
– Sore Throat
– Headache
– Fatigue/Muscle or Body Aches

High-Risk: Red Flag Symptoms (1 or more)

– Cough (new onset affecting quality of life)
– Difficulty Breathing
– Loss of Taste/Smell

 
Are you fully vaccinated?
You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine.
clock.png

Time is Up!

clock.png

Time's up

Self Assessment

Welcome to your Covid Self Assessment

Were you exposed to someone who tested positive for COVID-19?

True exposure is defined as:

– Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period

AND

– The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing).

Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms?

 

Low-Risk: General Symptoms (2 or more)

– Fever (≥100.4°F)
– Congestion/Runny Nose
– Nausea/Vomiting/Diarrhea
– Sore Throat
– Headache
– Fatigue/Muscle or Body Aches

High-Risk: Red Flag Symptoms (1 or more)

– Cough (new onset affecting quality of life)
– Difficulty Breathing
– Loss of Taste/Smell

 
Are you fully vaccinated?
You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine.
clock.png

Time's up

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    • About Allied
      • History of Allied
      • Join Allied
      • Mission, Vision & Values
      • Leadership
      • Careers
      • Contact Allied
    • Find a Location
      • Pediatrician Near Me
      • Family Medicine Locations
      • Allergy, Asthma, Immunology, Pulmonary & Sleep Medicine
      • Breastfeeding Medicine
      • Behavioral Medicine Services
      • Nutrition Services
      • Telehealth
    • Patient Resources
      • Patient Portal
      • Telehealth
      • COVID Self Assessment
      • Breastfeeding Support
      • Request an Appointment
      • Symptom Checker
      • Dosage Checker
    • Trusted Information
      • Patient Education
      • Webinars & Videos
      • Baby Basics
      • Asthma Control Education (ACE)
      • COVID Information
      • What to Expect
      • New-Parent Helpline
    • Bill Pay
    • Foundation