Elaine Ellis- Patient Demographics Form-COVID-19 Testing- January 2021
Elaine Ellis Center of Health (EECH) will be providing COVID-19 testing at IDEA PUBLIC CHARTER SCHOOL for staff and IDEA families. If you wish to participate, please complete the following information. *One Google form per person.
How are you connected to IDEA PCS?
IDEA Student/Family Member
IDEA Staff Member/Family Member
Date of Birth
I am registering for the following COVID Testing Date (check all that apply)
COVID-19 Testing- Thursday, January 28th 9:30 am- 10:30 am @ IDEA
Never submit passwords through Google Forms.
This form was created inside of IDEA Public Charter School.