Were you unable to get a COVID-19 test?
Do you have the symptoms of Coronavirus, (COVID-19), but were unable to get tested? Are you in a high-risk group, and have verified exposure to someone who has tested positive? Did you go to an ER or a doctor's office, but were told you could not get tested? Please report your details below.

All information is optional, except the date of your symptoms and your ZIP code. Any contact information you provide voluntarily will be used only by press and/or medical professionals to contact you. It will not be used for advertising, market research, or any commercial use.

Please also take the survey at https://www.buoyhealth.com/symptom-checker/ and report your results to Buoy Health.
Sign in to Google to save your progress. Learn more
What is this for?
We are collecting this information on a voluntary basis in order to share with the medical community.

According to the Washington Post:
"The number of medical professionals and patients who are denied access to tests is not tracked nationally. But in interviews, people from states as varied as Wisconsin, North Carolina, Washington, Indiana and New York said their doctors sought but were unable to get testing approval from local or state health officials." - https://www.washingtonpost.com/investigations/coronavirus-testing-denials/2020/03/12/a70eca1e-63df-11ea-912d-d98032ec8e25_story.html

We hope that self-reporting will bring attention to this lack of data, and help to fill in the gaps.

Please also visit https://reportcovidusa.com to report your symptoms and help track the spread of the virus.
Email Address
If entered, this will only be provided to press or medical professionals, and will not be used for marketing or advertising.
Consent to be contacted
On what date did you first notice the symptoms of the virus? *
Symptoms include a high fever, dry cough and shortness of breath. See: https://www.buoyhealth.com/diagnoses-a-z/coronavirus/
ZIP Code *
Additional Comments
Describe your experience and attempts to get a COVID-19 test. Why were you refused a test? Where?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy