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Prospective study participants must first prequalify. Please take a moment to complete this form so that we can get a better feel for your eligibility. If you appear to be potentially eligible based on the information you provide, you will be prompted to make an appointment to be tested for COVID-19 at the completion of this form.

What is your gender?*
Do you have one or more mild to moderate COVID-19 symptoms?*

Unfortunately, you are not eligible for this study and therefore can not be tested by our clinic.

Please check the answer that best describes your COVID-19 testing history.*

Unfortunately, you are not eligible for this study and therefore cannot be tested by our clinic.

Which best describes your interest in our COVID-19 study?*
Note: If you have not done so, please read carefully “About our COVID-19 Study”

Unfortunately, you are not eligible for this study and therefore can not be tested by our clinic.

Which of the following three criteria best describe you?*
AND
AND
AND
Do you confirm that NOLA Research Works has your permission to collect your personal information for the purposes of prequalifying you for this study?*
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