Survey

Question 01

What country are you from?

Question 02

What are your symptoms?

Fever

Caugh

Stomach Ache

Question 03

O1

O2

O3

O4

O5

Question 04

Please Choose additional symptoms

Breathing Issue

Chest Pain

Nausea

Question 05

What is your email address?

Question 06

What is your Phone Number?

Question 07

Choose a service date

What country are you from?	USA

What are your symptoms?	Fever

Rating	05 Very Good

Additional Symptoms	Breathing issue

What is your emai address	[email protected]

What is your phone number?	9153595870

Service Date	12/31/2020

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