01/12
How are you feeling?
Happy to hear that!
Next
We are sorry you are not feeling well!
02/12
Please tell us about your current symptoms?
next
03/12
Have you notified a sanitary-epidemiological
unit of your symptoms?
Next
04/12
Have you been examined by a doctor, e.g. through telemedicine?
Next
05/12
How many days have you been feeling unwell?
Next
06/12
Did you travel abroad 14 days before the symptoms appeared?
Next
07/12
Have you been in contact with
someone who could be infected with #COVID-19?
Next
08/12
Have you self isolated?
Next
09/12
Have you been quarantined?
Next
10/12
To the best of your knowledge do you suffer from any of the following diseases?
Next
11/12
Do you smoke?
Next
12/12
Have you recently received a flu vaccine?
Next
Next
Thank you for providing us with this information!

The data you provide helps scientists in the fight against the #COVID-19 pandemic.

By enabling push notifications, you allow us to send you reminders to fill in the questionnaire tomorrow as well as receive vital, official updates on the pandemic.
agree


Thank you for accepting the notifications!
The notifications are blocked. You can enable notifications manually in your browser.
Your form was registered but unfortunately your browser does not support our notifications.