Questionnaire for patients with fever and common cold symptoms
※Be sure to CHECK the □ above.
Please follow the procedure in the order of ①to②.
Please send us photos of your health insurance card and medical ticket.
※ Medical tickets : only to those who have them.
Please fill out all the forms below and press SEND.
※There is an obligation to report your occupation to health center if you are tested POSITIVE.
What is your symptom and problem？
Thank you for sending your information.