Pre-Register | Carnswellmc

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6241 Rosewood Ave. Central City, KL K28 T53

Tel: 990-121-0025

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First Name

Last Name

Email

Phone

Are experiencing any of the following symptoms? Check all that apply: * Required

None

Fever or chills

Cough

Shortness of breath or difficulty breathing

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

Are you feeling sick today? *

Yes

No

How would you like to receive your results? *

Email

Phone

Mail

Thanks for submitting!

6241 Rosewood Ave. Central City, KL K28 T53

Tel: 990-121-0025

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