Adult Care

Covid 19 Testing

Need COVID 19 testing? Schedule an appointment to speak with a doctor, get testing, and treatment of symptoms if deemed warranted by the physican. We make it easy to get tested. Contact us today and stay safe.

COVID SCREENING

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

First Name

Email Address

Last Name

Date of Birth

Phone Number

Have you experienced any of the following symptoms in the past 48 hours: • fever or chills • cough • shortness of breath or difficulty breathing • fatigue • muscle or body aches • headache • new loss of taste or smell • sore throat • congestion or runny nose • nausea or vomiting • diarrhea

Yes

Have you been in close physical contact in the last 14 days with: • Anyone who is known to have laboratory-confirmed COVID-19? OR • Anyone who has any symptoms consistent with COVID-19? Close physical contact is defined as being within 6 feet of an infected/symptomatic person for a cumulative total of 15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic individuals, 48 hours prior to test specimen collection).

Yes

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

Yes

Are you currently waiting on the results of a COVID-19 test?

Yes

Have you traveled in the past 10 days? Travel is defined as any trip that is overnight AND on public transportation (plane, train, bus, Uber, Lyft, cab, etc.) OR any trip that is overnight AND with people who are not in your household.

Yes

I certify that my responses are true and correct

Thanks for submitting!

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Family & Aesthetics Medical Centers, 12568 Broadway St. Ste. 160, Pearland, TX 77584

Phone: 832-619-1669

Fax: 760-267-9223

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