COVID Pos Results – Spanish

Patient First Name(s) (Required)

Patient Last Name(s) (Required)

Contact Email (Required)

Confirm Contact Email (Required)

Did you experience symptoms? (Required)
YesNo

Do you need your results in Spanish?
Yes

Do you need a letter to return to work?
Yes

Patient First Name(s) (Required)

Patient Last Name(s) (Required)

Contact Email (Required)

Symptoms (check all that apply)
Chills/ShiveringFeverHeadacheBody AchesSore ThroatChanges in Ability to Taste or SmellCoughDifficulty Breathing/Shortness of Breath