OP Portal COVID-19 Testing Illness Survey

Please correct the errors described below.

Please fill this form out only if your child is 5 or older AND you already have an appointment for a nurse to screen your child. If your child is asymptomatic and is fully vaccinated, there is no need to test for covid. Thank you.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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