COVID-19 Vaccine Screening
Gender
Race
Ethnicity
Are you feeling sick today? (Fever, Respiratory Infection, or other moderate/severe illness)
In the last 10 days, have you had a COVID-19 test or been told by a healthcare provider or health department to isolate or quarantine for COVID-19 infection or exposure?
Have you received antibody therapy (monoclonal antibodies or convalescent plasma) for COVID-19 in the past 90 days (3 months)?
Have you had any vaccines in the past 14 days (2 weeks) including flu shot?