Screen Reader Mode Icon

Question Title

* 1. What is your contact information?

Question Title

* 2. In the past 14 days, have you experienced or experiencing the following:

Question Title

* 3. In the past 14 days, have you experienced a high  temperature/fever over 99 degrees?

Question Title

* 4. Have you been diagnosed with COVID 19?

Question Title

* 5. Have you been knowingly exposed to COVID 19?

Question Title

* 6. Choose the type of screening in you would like:

Question Title

* 7. What type of sex do you have? (Choose the type of sex that you've had. This helps us test in the correct areas of possible exposure.)

Question Title

* 8. Do you inject drugs?

Question Title

* 9. Would you like to receive a text or email regarding your next appointment or other events Joseph H. Neal Health Collaborative has coming up?

Question Title

* 10. What day would you like schedule for your screening?

0 of 10 answered
 

T