Survey – CliniKits

Please describe the option that best describes your symptoms:

If you have both severe and mild symptoms, select severe.

Severe

If you have:

I have a fever of 102° F or higher, OR I have a fever that has lasted longer than 48 hours.

I can’t speak in full sentences or do simple activities without feeling short of breath.

I am having severe coughing spells, or I am coughing up blood.

My skin or lips or nail beds are blue.

I have severe and constant pain or pressure in my chest.

I feel very tired or lethargic.

I feel dizzy, lightheaded, or too weak to stand.

I am having slurred speech or seizures.

I do not feel like I can stay at home because I feel seriously ill.

Mild

If you have:

I have a fever between 100.4° F and 102° F, I am feeling feverish, or feel warm to the touch.

I have a new or worsening cough.

I have a new or worsening sore throat.

I am having flu-like symptoms (chills, runny or stuffy nose, headache, body aches, and/or feeling tired).

Ordering up to 5 kits

I am having shortness of breath that is not limiting my ability to speak.

I have new loss of taste or smell.

I have new nausea or vomiting.

None

If you have:

I am not having any symptoms or I am having symptoms not listed in the other two choices.

*If you feel like you are having a medical emergency, please call 9-1-1. If you are experiencing severe trouble breathing; continuous pain or pressure in your chest; feeling confused; or having diﬃculty waking up or staying awake; pale, gray, or blue-colored skin, lips, or nail beds; or any other emergency signs or symptoms, please seek immediate medical care.

Please describe the option that best describes your symptoms:

Severe

If you have:

Mild

If you have:

None

If you have:

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