Please Respond to the Following Set of Questions by Responding Yes or No
| Yes | No | |
|---|---|---|
| Are you a parent or primary caregiver for school-aged child or younger | ||
| Are you a primary caregiver for or lives with a person over age of 80 | ||
| Have you cared for a patient with diagnosed or suspected COVID-19? | ||
| Do you have any friends/close relative that have contracted COVID-19? | ||
| Have you been in quarantine for a potential exposure to COVID-19? |