I have read the contents of this form in its entirety and voluntarily consent to undergo diagnostic testing for COVID-19.
AGREEMENT FOR SELF-ISOLATION
The local health jurisdiction has determined that if you are under suspicion for having COVID-19 due to symptoms and testing requests, it is necessary to be placed in isolation in order to prevent the transmission of this infection. It is important for you to comply with this Isolation Agreement in order to protect the public’s health.
Your initial confirms that you consent to COVID-19 testing, and, if you have any of the symptoms, you will isolate yourself from any other people until you receive a negative test result.