CORONAVIRUS Health Questionnaire

How are you feeling?

Your answers are collected anonymously and aggregated to help healthcare providers gauge the spread of COVID-19. The questionnaires will help assess your risk factors for the infection and will be used to inform healthcare systems in Nepal. Our website also contains information on COVID-19, symptoms, and preventive measures that you can take to keep yourself, your family, and your community healthy. Questions are based on best available guidance from WHO, appropriate Nepal Government Departments, health agencies, and other stakeholders, and will be updated frequently. Participation and completion of this survey online does not determine nor diagnose COVID. If you are experiencing severe symptoms, immediately seek medical attention and counsel. Please review our Terms of Service for any concerns.

Please answer 7 yes/no question even if you are experiencing no symptoms

- Do you have high fever (>100 F)?

- Do you have a cough?

- Are you experiencing any difficulty in breathing?

- Are you 60 years of age or older?

- Do you have any of the following medical conditions- Diabetes, Heart Disease, Active Cancer, History of Heart-attack or Stroke, Asthma, COPD, Dialysis, or have weak immunity power?

- Have you traveled outside Nepal recently?

- Have you had close contact with someone who is coughing, has a fever, or is otherwise sick and has been outside of Nepal recently?

- Your Municipality?: