COVID-19 At-Home Test Kit Survey

Please describe the option that best describes your symptoms:

If you have both severe and mild symptoms, select severe.

Severe

I have a fever of 102° F or higher, OR I have a fever that has lasted longer than 48 hours.
I can’t speak in full sentences or do simple activities without feeling short of breath.
I am having severe coughing spells, or I am coughing up blood.
My lips or face are blue.
I have severe and constant pain or pressure in my chest.
I feel very tired or lethargic.
I feel dizzy, lightheaded, or too weak to stand.
I am having slurred speech or seizures.
I do not feel like I can stay at home because I feel seriously ill.

Mild

I have a fever between 100.4° F and 102° F, am feeling feverish, or feel warm to the touch.
I have a new or worsening cough.
I have a new or worsening sore throat.
I am having flu-like symptoms (chills, runny or stuffy nose, headache, body aches, and/or feeling tired).
I am having shortness of breath that is not limiting my ability to speak.
I have new loss of taste or smell.
I have new nausea or vomiting.
I have new diarrhea.

None

I am not having any symptoms or I am having symptoms not listed in the other two choices.

Based on the information you provided, we recommend that you not delay medical attention and seek testing for the virus from your healthcare provider. Please reach out to your healthcare provider as soon as possible to discuss your next steps in care.

If you feel like you are having a medical emergency, please call 9-1-1.

Call ahead before visiting your healthcare provider. This will help the healthcare provider’s office keep other people from getting infected or exposed.

If you have a medical appointment, let the healthcare provider know that you may have COVID-19.
Put on a facemask before you enter the facility to limit exposure to others.