COVID-19 Pre-Screening Questionnaire - Bridge Diagnostics

County Square Pharmacy

Welcome

Please enter patient information to setup a COVID-19 sample collection.



Female
Male
Other




Hispanic or Latino
Not Hispanic or Latino
Other
Prefer not to answer

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian and other Pacific Islander
White
Two or more races
Other
Prefer not answer

Yes
No