• COVID19 Appointment Request Questionnaire

    Test Times: Monday -Friday: 8:15a to 3:30p and Saturdays: 9am to 2pm and Sundays 12pm to 4pm
  • 1. Are you experiencing any of the following:

    • Fevers, chills, body aches
    • Difficulty breathing (e.g. struggling to breathe or speaking in single words)
    • Cough, Sore throat, runny nose
    • Chest pain, spitting out blood
    • Confusion or word finding difficulty
  • 2. Are you experiencing any of the following:

    • Pink eye
    • Persisitent headaches
    • Weakness or numbness in an extremitiy
    • Difficulty with speech 
    • Facial droop
  • 3. Are you experiencing any of the following:

    • Abdominal pain
    • Nausea and vomitting
    • Loose stoools
    • Bloody urine
  • 4. Have you travelled to any country within the last 14 days?

  • 5. Have you had close contact with a person with COVID-19 (probable or confirmed) while they were ill (cough, fever, sneezing, or sore throat)?

  • 6. Are you a health care worker?

  • 7. Do you have  having underlying chronic condition including diabetes mellitus, hypertension, chronic heart disease, chronic kidney disease, liver disease or a malignancy (cancer), asthma, emphesema or other lung disease

  • Clear
  • Clear
  • Thank you for submitting an appointment request form. Please wait for a call from our clinic to get scheduled.  

    The  address for MHC is 4825 Olson Memorial Highway, Golden Valley, MN, 55422

     

    Please wait in your car when you get to the clinic, call the clinic on 763 496 5708 and we will come to you. 

  • Should be Empty: