Hey There!

What is your first name?

What is your last name?

What is your email address?

What is your phone number?

Do you have any of the following severe symptoms?

Shortness of Breath
Persistent Fever
Persistent chest pain and pressure
Inability to wake or stay awake
Bluish lips or face
New mental confusion

Is your shortness of breath interfering with daily activity, normal functioning or is paired with chest pain, dizziness, fever, sweating or pain that spreads into jaw, arm, or back area?

Has your fever been hard to control for 3 or more days or is the fever associated with shortness of breath or any form of skin rash or severe headache or chest pain?

Do you have a NEW loss of taste or smell?

Do you have any of the following symptoms (Please only say “yes” if it is a new symptom and not a chronic condition)?

1. Mild fever between 100.4°F and 102°F
2. Mild shortness of breath
3. Dry cough
4. Headache (persistent)
5. Fatigue
6. Sore throat
7. Body aches
8. Runny / stuffy nose
(not seasonal allergies)
9. Nausea / vomiting

Have you tested positive for COVID-19?

Which of the following timeframes correlate with your results?

Have you been vaccinated for influenza (flu) this flu season (2020/2021)?

Have you been vaccinated for COVID-19?

Which vaccine have you received?

Have you received your second dose?

Has it been 2 weeks or more since you received your second dose (Pfizer/Moderna) or your single dose for J&J?

Have you traveled using public transportation or attended indoor venue gatherings of over ten people for over 15 minutes in the last two weeks?

Have you been in close contact (within 6 feet or less for over 15 minutes over a 24 hour period) with anyone with a confirmed COVID-19 diagnosis in the last 14 days?

We are getting your results