The City of Irvine, in partnership with Curogram, is offering drive-up COVID-19 PCR testing for individuals that live or work in Irvine. Please complete the below questionnaire to begin your appointment process. This information is confidential and is provided to Curogram for medical screening. Do you consent to testing?

Do you think you have been exposed to COVID in the last 14 days in any way?

In the past 14 days, have you had direct contact with anyone known to test positive for COVID-19?

If exposed to COVID, has it been more than 5 days since your exposure?

Are you experiencing fever?

Are you experiencing cough?

Are you experiencing shortness of breath?

Are you experiencing fatigue?

Are you experiencing body aches?

Are you experiencing headaches?

Are you experiencing loss of taste or smell?

Are you experiencing sore throat?

Are you experiencing congestion or runny nose?

Are you experiencing nausea or vomiting?

Are you experiencing diarrhea?

I UNDERSTAND THAT AT THIS TIME, THE TESTING SITE IS ONLY ACCEPTING APPOINTMENTS UNTIL AUG. 6TH, 2020. IF I SELECT AN APPOINTMENT TIME BEYOND THAT DATE, MY REGISTRATION MAY NOT BE ACCEPTED.

PLEASE COMPLETE ALL KNOWN FIELDS IN THE REGISTRATION PROCESS EVEN IF THERE IS NOT A RED ASTERIKS. MISSING DATA CAN DELAY YOUR REGISTRATION PROCESS. I UNDERSTAND AND AGREE TO PROVIDE ALL AVAILABLE INFORMATION.