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COVID-19 Testing and Results Enquiry Form

Please use this form if you would like to register for a COVID test, or if you are having difficulties registering for results by SMS.  You can also use this form if you would like a call back to discuss current criteria (symptoms) for COVID testing.  Please complete the following form with as much detail as possible; your details are required to assist us in processing your enquiry.

Reason for Enquiry

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Personal Details

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Date of Birth*
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Address / Town / State / Postcode
 

Address / Town / State / Postcode
 
In the last 5 years have you been admitted or attended a Hospital in NSW? 

 
Which Hospital (Most Recent)
Aboriginality:



 
 
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Do you need an Interpreter:

 

If you require an interpreter, please advise which language spoken.

Requests for COVID Tests require a Medicare Number
 

Requests for COVID Tests require a Position on Card
 
Medicare Card Valid To:
 

 

Next of Kin / Carer Details

First Name:
Surname:
 
 
Relationship to Patient:
Contact Number:

 
Address:
 

General Practitioner / Doctor Details



Doctor's Contact Number:
 

Comments

Symptoms, Special Needs, Reason for contacting COVID Triage Team
 
  
Last updated: 24 November 2020
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