Livonia Urgent Care & Medical Center

Location
Name*
First Last
Date Of Birth*
Date Format: MM slash DD slash YYYY
Phone*
Gender*
- Male
- Female
Email*
Insurance Card
Upload a copy of your insurance card
ID
Address*
Street Address Address Line 2 City State ZIP Code
COVID-19 Screening Questions
Disclaimer: The purpose of the Coronavirus (COVID-19) Self-Checker is to help you make decisions about seeking appropriate medical care. This system is not inteneded for diagonosis or treatment of disease or other conditions, including COVID-19. This system is inteneded only for people who are currently located in the United States.
Do you have a fever (greater than 100.4 F or 38.0 C) ?
- Yes
- No
Are you experiencing symptoms of lower respiratory illness suh ass cough, shortness of breath, difficulty breathing or score throat?
- Yes
- No
Have you returned from travel abroad in China, Iran, Europe or South Korea in the last 14 days?
- Yes
- No
Have you been in contact with someone who has traveled to one of these countries and is now sick ?
- Yes
- No
Have you been exposed to someone with know COVID-19 or who is currently being tested for COVID-19?
- Yes
- No

Shopping Basket

COVID-19 Screening Questions