COVID-19 At-Home Test Kit Survey
Please describe the option that best describes your symptoms:
If you have both severe and mild symptoms, select severe.

I have a fever of 102° F or higher, OR I have a fever that has lasted longer than 48 hours.

I can’t speak in full sentences or do simple activities without feeling short of breath.

I am having severe coughing spells, or I am coughing up blood.

My lips or face are blue.

I have severe and constant pain or pressure in my chest.

I feel very tired or lethargic.

I feel dizzy, lightheaded, or too weak to stand.

I am having slurred speech or seizures.

I do not feel like I can stay at home because I feel seriously ill.


I have a fever between 100.4° F and 102° F, am feeling feverish, or feel warm to the touch.

I have a new or worsening cough.

I have a new or worsening sore throat.

I am having flu-like symptoms (chills, runny or stuffy nose, headache, body aches, and/or feeling tired).

I am having shortness of breath that is not limiting my ability to speak.

I have new loss of taste or smell.

I have new nausea or vomiting.

I have new diarrhea.


I am not having any symptoms or I am having symptoms not listed in the other two choices.

Have you been exposed to the coronavirus in the past 2 weeks?
Please select the option that most closely describes your level of exposure
Testing Recommended

I've been asked to get testing by my healthcare provider, public health department, or a contact investigator.

Exposed or Sick Contact

Yes, I have been in close proximity* to someone who has been diagnosed with or presumed to have COVID-19

*within 6 ft. of the person for a prolonged period of time or being coughed on

Congregate Setting

Yes, I live or work in a place where people reside, meet, or gather in close proximity.*

*Includes nursing homes or other long term care facilities, healthcare settings, office buildings, workplaces, schools, group homes, homeless shelters, prisons, and detention centers.

Possible Exposure
Do any of the following statements apply to you?
Please select the first option if ANY of these apply to you:
High Risk

I am 65 years of age or older

I have been told by my doctor that I am very overweight or obese

I have a chronic condition (e.g. diabetes, high blood pressure, kidney disease or on dialysis, liver disease, lung disease, etc.)

I have a heart condition (e.g. previous heart attacks, heart failure, etc.)

I have a neurological condition that affects my ability to cough (e.g. had a stroke)

I am pregnant

I regularly use tobacco or nicotine products (e.g. cigarettes, e-cigarettes, vapes, hookah, etc.)

I have a condition that weakens my immune system or makes it harder to fight infections (e.g. AIDS, cancer, lupus, rheumatoid arthritis, solid organ or bone marrow transplant, etc.)

I am taking medication that weakens my immune system (e.g. steroids).

Low Risk

None of these apply to me.

Choose a payment option to continue:

I would like to use my insurance


I am not insured but I want to get free testing via CARES Act

Please fill out the information below
Please fill out the information below
Insurance Information

Your insurance denied your request.


You can still get free testing from the CARES Act


I am not insured but I want to get free testing via CARES Act

Registration Complete! Thank you for registering for your PreCheck unit.

Please download the PreCheck by XLabs app on your smartphone using Apple’s App Store or the Google Play Store to set up your profile/login information which will all you to receive at-home Covid test results directly via the app.

Additionally, please show this confirmation code to receive your PreCheck kit from the front desk at your SBE location.

Confirmation code:

Thank you!