Wild Health. Request for COVID-19 Results
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Email *
Phone number *
First Name *
Last Name *
Date of Birth *
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DD
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Date of Test *
MM
/
DD
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YYYY
Time of appointment (Approximation is acceptable) *
Site Location *
Please describe your situation to the best of your ability. You could include what kind of test did you receive, were there any complications during your testing, are you traveling in the near future (if so, please send the time and date of your flight/travel plans), etc. *
A copy of your responses will be emailed to the address you provided.
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