Covid Testing Online Form
Please fill required fields
Transaction Type
Walk-Thru
Drive-Thru

Covid Testing Schedule
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Patient Information
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Yes
No

Current Home Address
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Address Outside the Philippines
(for Overseas Filipino Workers and Individuals with Residence Outside the Philippines)

Travel History
History of travel/visit/work in other countries with a known COVID-19 transmission 14 days before the onset of your signs and symptomps:
Yes No

Exposure History
History of Exposure to known COVID-19 Case 14 days before the onset of signs and symptoms:
Yes No Unknown
Have you been in a place with a known COVID-19 transmission 14 days before the onset of signs and symptoms:
Yes No Unknown
If Yes: Place
Work Place
Health Facility
Social Gathering
Religous Gathering
Others, specify type:
Name Contact

Clinical Information
Fever
Yes
No
Yes
No
Yes No
Yes No
Yes No Pending