Health Checklist /Test Scheduling
Please fill out the below in order to schedule your test. If there are any “yes” answers we will reschedule your testing session.
Enter your first/last name:
Do you presently have any of these symptoms? Select all that apply.
Repeated shaking with chills
New loss of taste or smell
Shortness of Breath
Congestion or runny nose
Nausea or vomiting
None of the above
In the last month have you been in contact with someone who was confirmed or suspected to have the Coronavirus/COVID-19?
Never submit passwords through Google Forms.
This form was created inside of iowacentral.edu.