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COVID-19 Testing Intake and Consent Form Please fill out this form and email to the pharmacy prior to your appointment. Patient Information(Name, Date of Birth, and Gender MUST match passport)First
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Go to the website www.shluiowa.edu/results/covid-19/electronic-test
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Click on the 'COVID-19 Electronic Test Request' button
03
Fill out the required personal information such as name, contact details, and any relevant medical history
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Answer the questionnaire related to COVID-19 symptoms and exposure
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Who needs wwwshluiowaeduresultscovid-19electronictestcovid-19 electronic test request?

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Anyone who suspects they may have COVID-19 and wants to request an electronic test can fill out this form
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The wwwshluiowaeduresultscovid-19electronictestcovid-19 electronic test request is a form used to request a COVID-19 electronic test.
Individuals who need to get tested for COVID-19 are required to file the electronic test request.
To fill out the electronic test request, you need to provide your personal information, symptoms, and test preferences.
The purpose of the electronic test request is to streamline the process of requesting and scheduling COVID-19 tests.
The electronic test request must include personal information, symptoms, and test preferences.
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