Please enter your first and last name:
Have you had a fever, cough, shortness of breath, flu-like symptoms or loss of taste and smell in the last 10 days?
If yes, please include details:
Have you travelled outside of New York State in the last 10 days?
Have you travelled outside the US in the last 10 days?
Have you tested positive and been diagnosed with COVID?
Have you been in contact with someone who tested positive for COVID-19 or who had symptoms described in number 1 above in the last 10 days?
Have you received the 1st dose of vaccine?
Have you received the 2nd dose of vaccine?