COVID-19 - UT Health RGV - Request Phone Screening

Phone Number *

Area Code Phone Number
Next of Kin/Emergency Contact Name *
First and Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Zip Code *
Insurance Provider *
Optional
Member ID# *
Preferred Pharmacy *
Comments or Questions
Optional
What Happens Next?
- You can expect a call within 24hrs (M-F) of submitting this form.
- If you are tested for COVID-19, you can expect results within 48-72hrs* (M-F)
- Results will be sent to you via your patient portal account which is linked to your email. It is imperative you sign up for the patient portal in order to receive your results. We will call you only if you are positive .
*Periods of extreme testing volume may increase time of expected results.
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COVID-19 (coronavirus) Phone Screening Request