Basic Information
First Name*
Last Name*
Phone*
Email*
Enter Email Confirm Email
Birthday*
MM slash DD slash YYYY
Gender
- Male
- Female
Enter ZIP Code
Do you now have, or have you recently had?

Fever*
- Yes
- No
Fever Start Date
MM slash DD slash YYYY
Fever Stop Date
MM slash DD slash YYYY

Chills*
- Yes
- No
Chills Start Date
MM slash DD slash YYYY
Chills Stop Date
MM slash DD slash YYYY

Body aches*
- Yes
- No
Aches Start Sate
MM slash DD slash YYYY
Aches Stop Date
MM slash DD slash YYYY

Running Nose*
- Yes
- No
Runny nose Start Date
MM slash DD slash YYYY
Runny nose Stop Date
MM slash DD slash YYYY

Congestion*
- Yes
- No
Congestion Start Date
MM slash DD slash YYYY
Congestion Stop Date
MM slash DD slash YYYY

Sore Throat*
- Yes
- No
Sore throat Start Date
MM slash DD slash YYYY
Sore throat Stop Date
MM slash DD slash YYYY

Cough*
- Yes
- No
Cough Start Date
MM slash DD slash YYYY
Cough Stop Date
MM slash DD slash YYYY

Travel and Exposure

Have you recently traveled to a "Hot Spot" or been in contact with a person know to have coronavirus(COVID-19)?:*

Yes
No

Most Recent Date

Have you recently been in a group setting?

Yes
No

It appears based on your responses that you are not qualified for a test at this time

Antibody testing is most effective at least 14 days following the end of symptoms. We suggest scheduling or completing this test at a period at least 14 and not more than 30 days after your symptoms end.

It appears based on your responses that you ARE qualified for a test at this time

Test Location
Agency ID
Based on your zip code, the following collection locations are available to you*
- Lab (Las Cruces, NM location only)
- At Home (You will identify a medical professional to collect the specimen)
- Point of Care Facility
- Mobile Collection

Antigen Point of Care

Step 1 of 3

Basic Information

Do you now have, or have you recently had?

Travel and Exposure

Test Location

Antigen Point of Care

Step 1 of 3

Basic Information

Do you now have, or have you recently had?

Travel and Exposure

Test Location

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