COVID-19 Questionnaire

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Have you been administered a COVID-19 vaccination?(Required)
Have you tested positive for COVID-19 in the past 10 days?(Required)
Are you currently awaiting results from a COVID-19 test?(Required)
Have you been diagnosed with COVID-19 by a licensed healthcare provider?(Required)

Please note the following forms of documentation that are accepted. Please email: or contact our office for alternative confidential delivery methods at 918-894-2965
  • Vaccination Card
  • Positive Antibody Test Result
  • Negative Viral Test Result within 48 hours of the event