This questionnaire is designed to gather information regarding the COVID-19 pandemic currently affecting our country and offer guidance and instruction to ensure your safety.

I certify that I am:

At least sixteen (16) years of age and I consent to being tested by the South Carolina Department of Health and Environmental Control (DHEC) for COVID-19, 


I am the parent or guardian of a child under the age of sixteen (16), or the guardian of a vulnerable adult, and I give my consent for my child/ward to be tested by DHEC for COVID-19.

Additionally, by proceeding, I understand, acknowledge, and agree to the following:

1.    Participation in this testing is voluntary;
2.    Participation in this testing does not create a patient-physician relationship between myself or my child and DHEC, its employees, agents, partners, and volunteers;
3.    It is my responsibility to follow up with a healthcare provider of my choice regarding the test result; and
4.    I dismiss, release, and discharge DHEC and its employees, agents, partners, and volunteers, from any and all claims, demands, actions, and liability that may arise directly or indirectly from my participation or my child's participation in this event.

Please fill out the code below before proceeding.