COVID-19 Form

If you need immediate medical assistance please dial 911. If you are showing symptoms of COVID-19 please contact a local medical provider if you have not already done so. Any and all health information entered is done so voluntarily for the purpose of contact tracing. By submitting this form you are agreeing that all HIPPA rights are being waived in favor of the safety of the community. This form does not guarantee a medical professional will reach out to you.