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Create a 4 digit number to verify your test results.

I consent that I am being advised that if I am symptomatic, to quarantine myself until I receive my test results, to avoid exposure to the public. I understand it may take 5-7 days to receive my results.
I understand that I am being advised to consult with a medical doctor if I am having any symptoms that require medical treatment.
I understand, that this COVID testing site is being medically supervised by LV Imaging. I will be contacted by phone through a Telemedicine phone call, if I test positive, to receive instructions or treatment if needed.
You will receive an email from Marquis Labs if MY test is negative. If you do not receive the email please call Marquis Labs tel:4054456001.
I also understand that a positive result will be reported to CDC (Center of Disease Control) by Marquis labs.
If you are positive COVID 19, you must quarantine yourself for 10 days by CDC guidelines and consult with your doctor. If you are having difficulty breathing or an emergency call 911 or go to nearest emergency room.

Symptoms

(Please Select One)

Fever :
 No  Yes
Cough :
 No  Yes
Shortness of breath:
 No  Yes
Congestion :
 No  Yes
Lost of Taste :
 No  Yes
Body Aches :
 No  Yes
Nausea/Vomiting :
 No  Yes
Have you been in contact with someone who tested positive for COVID-19 ?
 No    Yes
Insured Not Insured

 
 
I certify all information is true and correct.


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Provided by Shaddai Solutions, LLC
March 03 2022 20:37:27.