COVID-19 Assessment

Please complete and answer yes or no to the following questions.









    In the last 14 days:












    After submission of the questionnaire, you will have three options.

    Option 1: Complete this survey and purchase the CRL Rapid ResponseTM test kit for yourself through Clinical Reference Laboratories (CRL). You can have an at-home collection kit delivered to you via Federal Express.
    Option 2: Contact your doctor or another authorized healthcare provider to discuss where in your community to get tested and, if symptomatic, where to get tested and/or treated for an active infection.
    Option 3: Find an in person testing location in your community.

    NOTICES
    * If you answer yes to one or more of the health questions in the questionnaire, please consider contacting your primary health provider for further evaluation.
    * By clicking submit, you agree with the terms, and understand that this resource is for adults 18+ in the United States or that you are the guardian or parent of the minor.
    * CRL Rapid Response TM is not intended for urgent situations.
    * Please do not rely on this test for immediate evaluation and turnaround. Test will result within 24 hours upon receipt of specimen in the lab.
    * This questionnaire is private and secure. Your answers are not collected or shared with anyone other than the laboratory or the physician reviewing the results.
    * The CDC states that anyone exposed to a COVID-19 infected person for more than 15 minutes needs a test.
    * The CRL Rapid ResponseTM saliva based molecular COVID-19 test is self collected and shipped between you and the lab. After submission of the questionnaire you will be directed to the CRL website.
    * CRL Rapid Response TM is not FDA approved or cleared but is FDA authorized under EUA

    Physician: Ram Dandillaya, MD
    Atelier Health Office: 310-854-4995