Age: A Survey on Mid-East Respiratory Syndrome

SURVEY ON MIDDLE EAST RESPIRATORY SYNDROME
Name:
Age: Profession:
Sex: Place:
Please specify your response:
1. Are you currently suffering from any illness or disease?
 Yes
 No
If yes, specify:
2. Are you facing any sort of complications during breathing?
 Yes
 No
If yes, specify:
3. Are you currently facing any of the symptoms listed below?
 Diarrhoea
 Fever
 Cough
 Pneumonia
4. Are you suffering from any of the disease, listed below?
 Lung disease
 Renal disease
 Diabetes
 Cancer
5. Have you ever been in contact (direct or indirect) with camels?