You should be prepared for COVID-19 and it is so important to have an idea of your risk-level and prepare accordingly, especially if you have a chronic medical condition or if COVID-19 has impacted your community.
Take the quick survey below – even if you don’t have symptoms – to help estimate your risk and receive a personalized recommendation on taking care of yourself and your loved ones. Your answers to the survey will be used to provide you with a personalized recommendation and get you the support you need.
We encourage you to take this survey if your circumstances change, or you think you have new symptoms. You can also call your Personal Medical Concierge or our switchboard 888-414-1413 and they can help walk you through it.
This survey and associated recommendations do not constitute medical advice. This survey and associated recommendations are not meant to be a substitute for professional medical advice, including diagnosis or treatment. Contact your physician with any questions you may have regarding COVID-19 or your personal health. If you are experiencing a medical emergency, dial 911 for immediate assistance.

By filling out this risk assessment survey, you consent to Reliance Medical Centers sharing your data so we can support you with direct care and care coordination.

*All fields are required

Exposure Evaluation

Questions in this section help us understand the likelihood of whether or not you’ve been exposed to the virus.

1. Have you been near someone with symptomatic, laboratory-confirmed (or test results pending) COVID-19 infection? *

 
 

2. Were you within 6 feet of the patient for at least 30 minutes?

 
 

3. Do you live in the same household, are the intimate partner of, or are providing care for a person with symptomatic, laboratory-confirmed COVID-19 or a person who has been tested but not yet received results?

 
 

4.

Personal Risk

Questions in this section help us understand if you’re at risk for complications from COVID-19 if you were to be infected.

Do you have any chronic medical conditions?

 
 

5. Are you over the age of 60? *

 
 

6. Do you, or have you ever, smoked? *

 
 

7. If applicable, are you pregnant or have you been pregnant in the last two weeks?

 
 

8.

Symptom Evaluation

The question in this section helps us understand your current symptoms if you have any.

Do you have any flu symptoms such as high fever and constant dry cough?

 
 

To learn more, fill in your details below:

To learn more, fill in your details below:

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