Covid Profile

Questionaire

Contra2020, for your health!
Please complete your Contra2020 form, COVID-19.

Create your SYMPTOMS/TREATMENT HISTORY, complete form and select CREATE HISTORY:

Selfie Passport Federal ID

YOUR VITAL STATISTICS

COVID-19 CDC SYMPTOMS

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

Recent travel:

Yes No
Yes No

Tests and Shots

Yes No
Yes No
Yes No
Yes No Pending
Yes No Pending
Yes No
Yes No
Yes No Pending
Yes No Pending
Yes No