Weimar ISD COVID-19 Test Request Form
   Leslie Kloesel, RN - WISD District Nurse                           Stacy Heger, WHS Principal
             lkloesel@weimarisd.org                                               sheger@weimarisd.org
                      979-725-6331                                                                  979-725-9504
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This form is for Weimar ISD employees and students or Weimar High School only who wish to request on-site COVID-19 testing. If you are not an employee or student of Weimar High School and are seeking testing for COVID-19, you should not use this form. Please contact your local doctor for testing sites available.
This form must be filled out in it's entirety in order to make the testing process go smoothly. For questions, please contact Stacy Heger.
Drivers License Number *
First Name *
Last Name *
Date of Birth *
Email address *
Race/Ethnicity *
Home Address *
Phone Number *
Is this the first test (of any kind) you have had for COVID-19 testing? *
If NO, what type of test have you had before?
Clear selection
If NO, what was the test date?
Are you having COVID-19 symptoms? *
If yes, you MUST check all symptoms that apply. *
Required
Date symptoms started or Direct Contact. *
Date to be tested *
MM
/
DD
/
YYYY
Please select which testing time will work for you. *
Submit
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