512 - 374 - 9977

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ProResults Covid-19 Test Screening Form

Please fill out form in full in order to be considered for testing..

First Name

Last Name

Address

City

State

ZIP

County of Residence

Phone

Email

Birth Month

Birth Date

Birth Year

Gender

Ethnicity

Have you tested positive for Covid-19

Production Company or Project

If yes, what date did you test positive?

Date you will take RT-PCR Test

Initials for Signature

Today's Date

I declare that the info I’ve provided is accurate & complete

Thank you for your submission!

Please follow the instructions you receive from the production company in regards to your testing timeslot.
If you have any other questions, please contact our office at 512-374-9977

HOURS OF OPERATION:

MONDAY - FRIDAY

10 am - 5 pm

Saturday

~ Limited Appointments ~

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512 - 374 - 9977

7801 N Lamar Blvd B-159

Austin, Texas 78752

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