Coronavirus (COVID-19) consent form
Coronavirus disease (COVID-19) getting tested when you do not have symptoms
(asymptomatic testing). What you need to know
I have read and understood the attached information sheet and consent to be tested
for COVID-19 under the asymptomatic testing program for healthcare workers
This form below requires your contact details and contains brief questions on any current
symptoms you may have. Providing your contact details will help your health service contact
you with your test results.
Full name
Date of birth
Do you identify as:
Select one:
Neither Aboriginal nor Torres Strait Islander
Aboriginal but not Torres Strait Islander
Torres Strait Islander but not Aboriginal
Aboriginal and Torres Strait Islander
Prefer not to say
Residential address
Contact number
Please specify where
the test was taken
Health service:
Date of test