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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.

To help us manage demand, please indicate if you are currently on site waiting for COVID test at one of our clinics.

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Reason for Enquiry

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Personal Details

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Date of Birth*
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Address / Town / State / Postcode
 

Town
 
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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