Request COVID Antibodies Test
Please complete this form if the following apply:
1. You are currently on the Bay islands
2. Think you may have had COVID and would like to take an antibodies test when they are available.

Please complete ONE form per person, including each child.
First question asks for your email (correo electrónico)
Email *
First Name *
Last Name *
Phone Number *
Enter only digits, no dashes
Which Bay Island do you live on? *
Which Municipality do you live in? *
Which area of the island do you live? *
What date do you think you contracted COVID-19? *
Please enter month and year
Where do you think you contracted COVID? *
Enter Town/City and Country
If you think you contracted COVID-19 off island, which date did you return to the Bay Islands?
Have you taken or are you already scheduled to take an Antibodies Test for COVID-19? If yes, please provide date and location *
Any other relevant information? (e.g. Do you think it might have been dengue, what symptoms did you have etc.)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy