Are you feeling ill today? Do you currently have a temperature of 100 degrees or more? In the last 48 hours, have you experienced any flu-like symptoms such as fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, congestion or runny nose, nausea or vomiting, or diarrhea?


Yes
No




In the last 10 days, have you: tested positive for COVID-19 or taken a COVID-19 test and are awaiting results; been in contact with someone with confirmed COVID-19; been hospitalized or visited the emergency room for COVID-19 or related symptoms; been told by a medical professional to quarantine?

If yes, you are advised to self-quarantine for 14 days per recommendation of the Center for Disease Control (CDC) and the New York State Department of Health. Please schedule your flu vaccine for the 2020-2021 influenza season for a date outside the recommended 14-day window. Click here for list of state/territories with restricted NYS COVID-19 Travel Advisory


Yes
No