Survey Form
Name:
Gender:
Male
Female
Other
Symptoms:
Fever
Dry cough
Shortness of breath
Sore throat
Address:
District:
Thiruvananthapuram
Kollam
Pathanamthitta
Alapuzha
Kottayam
Ernakulam
Idukki
Thrissur
Palakkad
Malappuram
Kozhikode
Wayanad
Kannur
kasaragod