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Locations
Why Us
Tests
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About CovClinic
Contact
Corporate Testing
More FAQs
Skip the Line
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Registration
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Pre-register for your COVID-19 Test appointment by filling out the form below. Once completed, you can book your appointment day/time.
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First Name
Middle Name
Last Name
Birthday
Phone Number
Address
City
State
Zip Code
Signature
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By digitally signing this form, I am certifying that the above information is true.
Reason for Visit
Possible Exposure
Feeling Symptoms
Caregiver
Living with immunocompromised individual
Putting others at risk
Have you been experiencing any symptoms?
Cough
Loss of Taste
Shortness of Breath
Muscle or Body aches
Fever / chills
Loss of Smell
Nausea
Sore Throat
Runny Nose
Fatigue / Weakness
Vomitting
Nasal Congestion
Headache
Diarrhea
No Symptoms
Symptom duration?
1-3 Days
3-7 Days
>7 Days
Do you have insurance?
Yes
No
Provider Name
Subscriber ID
Subscriber Name
Group ID
Attest
I attest that I am uninsured and/or do not have a government ID
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