COVID-19 Pre-Screening Questionnaire - Bridge Diagnostics

Welcome

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


Waukesha


Female
Male
Other
Other
SSN (Preferred)
State Id
Drivers License
Passport





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