COVID-19 Testing Registration

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Case #
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SPECIAL NOTICE (08/04/2020)

We are now working with multiple laboratories in order to reduce turnaround time, in an effort to better serve our community and provide quick results. Testing is performed in order of priority, and will be sent to the best outside lab which can serve you.

Testing is available to those who live or work in Blanco County.

If you have been exposed to COVID-19, but do not have symptoms, you are required to quarantine for 14 days, regardless if you are tested and regardless of your test results.

If you have questions regarding testing, please call our hotline at (844) 868-8308.
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Patient Name* This field is required.Please enter the patient's name EXACTLY as it appears on any identification cards.
First Name
Last Name
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Patient Date of Birth* This field is required.
Date
Month
Day
Year
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Patient's Gender* This field is required.
Male
Female
N/A
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Patient Phone Number* This field is required.Enter a number where our testing staff can reach you. Cell phone preferred. If you enter a cell phone number, a text message will be sent once your results are available.
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Patient's Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Is the patient currently experiencing symptoms of COVID-19?* This field is required.
YESNO
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What symptom(s) is the patient currently experiencing?
Fever (Higher than 99.6 F)
Cough
Fatigue
Shortness of Breath
Muscle or Joint Pain
Sore Throat
Chills
Nausea or Vomiting
Diarrhea
Lost of Taste
Lost of Smell
Headaches
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On what date did these symptoms begin?
Date
Month
Day
Year
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Has the patient had close contact with someone with COVID-19?* This field is required.Close contact means within 6 feet for 15 minutes or longer.
YESNO
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On what date was the patient was exposed to a confirmed COVID-19 case?
Date
Month
Day
Year
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Does the patient have any of the following underlying health conditions?* This field is required.
Asthma
BMI > 30
Cancer
Congestive Heart Failure
COPD
Coronary Artery Disease
Hypertension
Immune Compromised
Kidney Disease
Liver Disease
None
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Do any of these classifications apply to this patient?* This field is required.
Healthcare Worker (HCW)
First Responder (Police/Fire/EMS)
Critical Infrastructure Employee
None
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Does this patient have any type of Medical Insurance?* This field is required.*NOTE: Insurance is NOT required for testing, but we are required to ask. Medically necessary tests are covered 100% by insurance or via the CARES Act fund if uninsured.*
YESNO
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Patient's Medical Insurance Information
Insurance Carrier
Insurance ID Number
Insurance Group Number
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Financial NoticeBased on the information you entered, it appears that your COVID-19 test is NOT medically necessary. Blanco County personnel will still gladly perform your test, and while we do not charge for testing, the accredited laboratory where your test will be sent does charge a fee. Both the performing laboratory and Blanco County will seek payment for your test from all available federal, state and local funding sources, including CARES Act funding. However, if all of these claims are denied, you will be responsible for the laboratory fees associated with your test. The laboratory fee for your test will not exceed $100, and is typically less than this. We are committed to ensuring access to testing for everyone, and financial assistance / charity care programs are available to those who qualify based on need. By continuing with testing, you are agreeing to accept financial responsibility for your test, if your testing claim is denied by all available funding sources.
I have read this notice and accept financial responsibility for my test.
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