Report an illness - COVID-19
By submitting this form, you agree that (i) you are voluntarily providing the information included in the form, (ii) the form is not to be used as a request by you for medical treatment, and (iii) all of the information you provide may be disclosed to and used by appropriate university officials, on a need-to-know basis, to address any health and safety concerns of the Lipscomb community.
Email address *
Full name *
Your answer
L number
Your answer
Phone number *
Your answer
Email address *
Your answer
Role in the Lipscomb community *
Do you live on campus? *
Where are you currently staying while ill? *
Your answer
Have you recently traveled internationally?
If yes, what countries did you visit?
Your answer
Have you been in contact with a person with a labaratory-confirmed case of coronavirus? *
Have you been tested for Coronavirus? (COVID-19) *
If yes, what was the result?
Please provide any additional information that might be helpful in caring for the health and safety of the Lipscomb community:
Your answer
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