Family Health Connections

 Phone: 410 -465 -5451

        443 280 2407

 M-F 9AM -  6PM

SAT-10 AM-3PM

Fax: (410)360 6459

9055 Chevrolet Drive Suite 205

Ellicott City, ​MD 21042

COVID-19 Screening Questionaire

FAMILY HEALTH CONNECTIONS

( if you don't have please enter cash or your SSN)
Have you traveled to the following countries in the past 45 days (check all that apply)*
Have you had close contact (being within 6 feet or that person for an extended amount of time) with a confirmed case of COVID-19 in the past 45 days?
Has a Public Health Official communicated that you were potentially exposed to COVID-19?
Have you had any of the following symptoms over that past 30 days? *
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On The Day of Testing For Covid -19

Dear Clients

Please be advised that our hours for testing has changed to 8am - 1pm and 3-5pm Monday to Friday and 9am -3pm on Saturdays. Please request appointments during these time slots.

When you arrive for testing, find a space and park in front of the building. There is usually a white table with a clipboard in front of the building towards the door entrance at your left. Pick one lab slip per person being tested and fill out the highlighted areas

for QUEST DIAGNOSTICS and LABCORP

laboratories. Please be sure to write your name, date of birth, address, email, phone number and more importantly your insurance

information CLEARLY!

Call 410 465 5451 when you are done filling out the lab slips. The testing is done inside your car in the parking lot.

IF YOU DO NOT HAVE INSURANCE BE SURE TO PUT YOUR SOCIAL SECURITY NUMBER ON THE LAB SLIP. FAILURE TO PROVIDE THESE INFORMATION WILL DELAY PROCESSING OF YOUR SPECIMEN AND CONSEQUENTLY DELAY YOUR RESULTS!

The nurse practitioner will see you and collect the specimen

Please NOTE the laboratory where your specimen is sent to by the lab slip you filled .

.

THANKS IN ADVANCE FOR YOUR MAXIMUM CO OPERATION

QUEST DIAGNOSTICS -866 697 8378 and download MYQUEST APP. Your result will be made available to you in the app when it is ready.

LABCORP- 800 - 845 6167 and go to their website and create a PATIENT PORTAL and you will be able to access your results when it is ready. We will call you with your results within 2-3 days

Please contact your primary care for work slips or excuse duty slips.

Thank you very sincerely!


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