Covid-19

COVID-19 QUESTIONNAIRE

Sorors Only. Please take this questionnaire in advance of chapter meeting.

* Indicates required field

Name *

First

Last

Phone *

Email *

Do you currently have a fever? *

Yes No

Do you have excessive cough and/or difficulty breathing? *

Yes No

Are you experiencing new loss of taste or smell? *

Yes No

Have you been in contact with someone confirmed with corona virus infection? *

Yes No

Submit

Louisville Alumnae Chapter
P.O. Box 32351
Louisville, KY 40232