Should you get tested for Covid-19?

Medical Questionnaire

Please fill out the following form to help us understand your physical condition.

Do you have symptoms of Covid-19?
Have you been in close contact (within 6 feet of an infected person for at least 15 minutes) with someone with confirmed Covid-19?

© 2017 Houndstooth Planning Company LLC

Onsite Draw Center
547 Grand Blvd Kansas city MO, 64106

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Phone 816-295-2795

Fax 816-945-8808

Mobile 913-912-9626