my.primary.health.cdphe.access.irugyou.com Open in urlscan Pro
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POST https://my.primary.health/test_groups/cdphe/support

<form method="post" data-parsley-validate="true" action="https://my.primary.health/test_groups/cdphe/support" id="kustomer_form" novalidate="">
  <input type="hidden" name="location_url" value="https://my.primary.health/t/cdphe/r?access_code=693699DEEB">
  <input type="hidden" name="test_group" value="cdphe">
  <input type="hidden" name="org" value="COVID Check CO">
  <input type="hidden" name="org_support_phone" value="">
  <input type="hidden" name="org_email" value="support@covidcheckcolorado.org">
  <input type="hidden" name="user_access_code" value="693699DEEB">
  <input type="hidden" name="_wpcf7_locale" value="">
  <input type="hidden" name="zen_subject" value="Website User Support">
  <div class="form-row">
    <div class="col-md-6">
      <label for="kustomer_contact_name" class="form-label">Contact Name *</label>
      <input type="text" name="zen_name" required="required" aria-required="true" class="form-control" id="kustomer_contact_name" placeholder="John Doe">
    </div>
    <div class="col-md-6">
      <label for="kustomer_email" class="form-label">Email *</label>
      <input type="email" name="zen_email" required="required" aria-required="true" class="form-control" id="kustomer_email" placeholder="Email">
    </div>
  </div>
  <div>
    <label for="kustomer_phone_number" class="form-label">Mobile Phone Number</label>
    <input type="tel" name="phone_number" autocomplete="tel-national" class="form-control" id="kustomer_phone_number" placeholder="Mobile Phone Number">
  </div>
  <div>
    <label for="kustomer_ticket_type" class="form-label">What is this regarding? *</label>
    <select id="kustomer_ticket_type" required="required" aria-required="true" name="ticket_type" class="form-control" data-parsley-is-selected="">
      <option></option>
      <option value="test">Test</option>
      <option value="vaccine">Vaccine</option>
      <option value="other">Other</option>
    </select>
  </div>
  <div>
    <label for="kustomer_confirmation_code" class="form-label">Confirmation Code (if known)</label>
    <input type="tel" name="appointment_access_code" autocomplete="tel-national" class="form-control" id="kustomer_confirmation_code">
  </div>
  <div class="form-row">
    <div class="col-md-6">
      <label for="inputCity" class="form-label">City</label>
      <input type="text" name="city" class="form-control" id="inputCity">
    </div>
    <div class="col-md-6">
      <label for="inputState" class="form-label">State</label>
      <select id="inputState" name="state" class="form-control">
        <option></option>
        <option value="AL">Alabama</option>
        <option value="AK">Alaska</option>
        <option value="AZ">Arizona</option>
        <option value="AR">Arkansas</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DE">Delaware</option>
        <option value="DC">District Of Columbia</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="ME">Maine</option>
        <option value="MD">Maryland</option>
        <option value="MA">Massachusetts</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NV">Nevada</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NM">New Mexico</option>
        <option value="NY">New York</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VT">Vermont</option>
        <option value="VA">Virginia</option>
        <option value="WA">Washington</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
        <option value="WY">Wyoming</option>
      </select>
    </div>
  </div>
  <div>
    <label for="kustomer_message" class="form-label">Message *</label>
    <textarea class="form-control" required="required" aria-required="true" name="zen_desc" id="kustomer_message" rows="3"></textarea>
  </div>
  <button type="submit" class="btn btn-primary" id="kustomer_submit">Submit</button>
</form>

Text Content

English
EnglishEspañol

History

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Name

WALID AL HABBOUL

Date of birth

1993-07-11

--------------------------------------------------------------------------------

Book follow-up appointment

WALID AL HABBOUL'S HISTORY

SUMMIT LABS SALIVAFAST

Results Ready

Administered February 22, 2022 10:18 AM
at 1600 California Street, Denver, CO, US

Result
Negative, No Detection of COVID-19 Virus



RT-QPCR TEST

The PCR test determines whether a person is actively infected with COVID-19
(i.e. Positive or Negative).

If no virus is detected, you have no evidence of active COVID-19 infection.
However, the test may miss a small proportion of cases, so please note that a
negative test is not a guarantee you do not have COVID-19.


WHAT YOUR RESULTS MEAN IF YOU TEST NEGATIVE:

 * Remember to wash your hands, avoid touching your face, practice social
   distancing, and wear a cloth facemask.
 * Sometimes, a person can test negative even if they have COVID-19 (false
   negative)
 * Just because you are negative now does not mean you will stay negative – you
   could become ill at any time

Book follow-up appointment

CONTACT US


SUCCESS!

Your request has been received. We sent you an email with your confirmation.

Contact Name *
Email *
Mobile Phone Number
What is this regarding? * Test Vaccine Other
Confirmation Code (if known)
City
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware
District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Message *
Submit
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