NCTC
Treatment Questionnaire
Have you tested positive for COVID?
If you'd prefer to speak with a person and need assistance regarding therapeutic options or locating a testing site, call 1-800-401-0946 between 7:00AM to 8:00PM, 7 days a week.
None of these answers are saved, tracked or recorded.
Do you have any of the following symptoms?
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
None of these answers are saved, tracked or recorded.
When did your symptoms start?
None of these answers are saved, tracked or recorded.
Are you older than 12 years old?
None of these answers are saved, tracked or recorded.
Does the child/patient have any of these conditions that would put them at a higher risk for severe illness?
- Diabetic (Type I or II)
- Chronic or Acute Kidney Disease
- Have Immunosuppressive Disease or receive Immunosuppressive Medication or Treatment
- Hypertension
- Chronic Lung Disease such as Asthma or COPD
- Heart Disease
- Pregnancy or Breastfeeding Sickle Cell Disease
- Neurodevelopmental Disorders, like Cerebral Palsy
- Need for medical device, like G Tube, Tracheostomy, or CPAP/BIPAP machine
- Member of racial or ethnic minority
- Obesity or Overweight
None of these answers are saved, tracked or recorded.
Do you have any of these conditions that would put you at a higher risk for severe illness?
- Diabetic (Type I or II)
- Chronic or Acute Kidney Disease
- Have Immunosuppressive Disease or receive Immunosuppressive Medication or Treatment
- Hypertension
- Chronic Lung Disease such as Asthma or COPD
- Heart Disease
- Pregnancy or Breastfeeding Sickle Cell Disease
- Neurodevelopmental Disorders, like Cerebral Palsy
- Need for medical device, like G Tube, Tracheostomy, or CPAP/BIPAP machine
- Member of racial or ethnic minority
- Obesity or Overweight
None of these answers are saved, tracked or recorded.
Are you currently pregnant?
None of these answers are saved, tracked or recorded.
Have you been exposed to COVID?
None of these answers are saved, tracked or recorded.
Are you immunocompromised or meet any of the following criteria?
- Have a body mass index (BMI) ≥35
- Have chronic kidney disease
- Have diabetes
- Have immunosuppressive disease
- Are currently receiving immunosuppressive treatment
- Are ≥65 years of age
- Are ≥55 years of age AND have cardiovascular disease, or hypertension, or chronic obstructive pulmonary disease/other chronic respiratory disease
- Are 12 – 17 years of age AND have a BMI ≥85th percentile for their age and gender based on CDC growth charts; OR have a sickle cell disease; OR a congenital or acquired heart disease; OR a neurodevelopmental disorder, for example, cerebral palsy; OR a medical-related technological dependence, for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19); OR asthma, reactive airway or other chronic respiratory disease that requires daily medication for control
None of these answers are saved, tracked or recorded.
Are you fully vaccinated?
None of these answers are saved, tracked or recorded.
You may quailfy for treatment!
Please review the following factsheets below, before to booking an appointment.
If you'd prefer to speak with a person and need assistance regarding therapeutic options or locating a testing site, call 1-800-401-0946 between 7:00AM to 8:00PM, 7 days a week.
No Treatment Recommended
Based on your answers on the screening questionnaire, you do not quailfy for any of our treatment options at this time.
Answered a question wrong? please click below.
If you'd prefer to speak with a person and need assistance regarding therapeutic options or locating a testing site, call 1-800-401-0946 between 7:00AM to 8:00PM, 7 days a week.