St Louis COVID-19 Response Web App

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What Type of Concern
Symptoms
Pre-Existing Conditions
Have you tested positive?
Have you recently travelled to an area with known local spread of COVID-19?
Have you come into close contact (within 6 feet) with someone who has a laboratory confirmed COVID-19 diagnosis in the past 14 days?
Do you have a fever (greater than 100.4 F or 38.0 C) OR symptoms of lower respiratory illness such as cough, shortness of breath, or difficulty breathing?
Do you have access to resources (food, water, medications, help)?
Do you think you may have had the COVID-19 virus and have now recovered?
Have you been Diagnosed?
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Your Information

First Name
Last Name
Zip Code
Address
Age
Blood Type
Code
Area Code
Phone
Type
Email
Additional Comments (Optional)
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone
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