COVID-19 Vaccine & Negative Test Upload
To meet the COVID safety requirements for the Discuss 2022 Conference, please complete the below form by 10:00 PM PST on June 21. Data is stored on a secure, HIPAA-compliant server.
Attendee Name
*
First Name
Last Name
Attendee Email
*
Attendee Date of Birth
*
-
Month
-
Day
Year
Full Vaccination Required
Attendees are considered fully vaccinated if it has been at least 14 days after the second dose of a two-dose series vaccine, or at least 14 days after a single-dose vaccine. Booster shots are strongly recommended. If you were vaccinated in the U.S., please upload your CDC vaccination card. If you were vaccinated outside the U.S., please upload an official immunization record that includes: first name and last name; date of birth; vaccine product name (only vaccines authorized by the WHO are acceptable); date(s) administered; and site where the vaccine was administered, or name of the person who administered it.
Please Upload the Attendee's Vaccine Record
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Negative COVID-19 Test Result
Attendees are required to take a PCR or Antigen test no earlier than June 20 at 8:00 am. The test report must show the guest's name, date of birth, date and time test was administered, type of test, test result, and the name of the lab or administering physician.
Date and Time of COVID Test
*
-
Month
-
Day
Year
Minutes
AM
PM
AM/PM Option
Please Upload the Attendee's Negative COVID-19 Test Result
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please click here if you had a recent positive COVID-19 Infection
Prior Positive COVID-19 Infection
If the attendee tested positive for COVID-19 between May 21 and June 11, they may be exempt from the testing requirement. Please upload the attendee's prior positive COVID-19 test result below and modMD's medical team will review.
Date of Prior Positive COVID-19 Test
-
Month
-
Day
Year
Please Upload the Attendee's Prior Positive COVID-19 Test Result
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit Request
Should be Empty: