COVID-19 Pre-Screening Questionnaire - Bridge Diagnostics


Welcome

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


Waukesha



Female
Male
Other
Unknown

State Id
Drivers License
Passport
SSN





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