Name
Email
Phone
Gender
Male
Female
Other
Symptoms
Fever
Dry cough
Fatigue
Ongoing chest pain or pressure
Can’t wake up
Bluish lips or face
District
Trivandrum
Kollam
Pathanamthitta
Australia
Alappuzha
Kottaym
Idukki
Ernakulam
Thrissur
Palakkad
Malappuram
Kozhikode
Wayanad
Kannur
Kannur
Address
Postal code