COVID-19 Self Assessment Please respond to the following questions to ensure the safety of all those at Fraser & Souweidane P.C. Full Name* First Last Email Address* Have you traveled out of the State of Michigan or been in close contact with anyone who has in the last 14 days?* Yes No Have you been in close contact with or cared for anyone diagnosed with COVID-19 in the last 14 days?* Yes No Have you experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problem)?* Yes No What is your temperature today?* CAPTCHA
