Baltimore Jewish Community Covid Testing Registration

All information is kept strictly confidential and is only shared as required by law.

What is your reason for being tested? *

Covid-19 symptoms

Possible exposure to Covid-19

Work-related or precautionary testing

School-related testing

Follow-up for previously testing positive

Are you testing as part of an organized business or group testing? *

Yes

No

What are your symptoms? Check all that apply. *

When did your symptoms start? * +

Where might you have been exposed? *

Which Shul did you attend? *

Fever or chills	Cough
Shortness of breath or difficulty breathing	Headache
Loss of taste or smell	Sore throat
Congestion or runny nose	Nausea or vomiting
Diarrhea