COVID-19 Test Result Enquiry
* Required
Email address
*
Your email
Only use this request form if test was done at the Monroe Community COVID-19 Testing Site on Morton Street.
PLEASE NOTE
*No test results will be given automatically by submitting this request.
*No test results will be released verbally when contacted by a team member.
*Test results will only be released to the Patient that got tested, unless 17 years of age or younger to their legal Parent or Guardian (As per the registered contact information on file)
*Results can only be sent via Email, Fax or secured link via text (If available)
Patient First Name?
*
Your answer
Patient Last Name?
*
Your answer
Patient Date of Birth?
*
MM
/
DD
/
YYYY
Patient Date Tested?
*
MM
/
DD
/
YYYY
Contact Number?
*
Your answer
Relation to the Patient?
*
I am the Patient
I am the Legal Parent
I am the Legal Guardian
Other:
Reason for this request?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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