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Before you make the pre-registration of your appointment, you must fill in your information in the form of Epidemiological Study of the Federal Government of Mexico. This form is required by law and is required to be filled in for each person undergoing a Covid-19 detection test.

Approximate fill time: 10 minutes

Epidemiological Study Form

Clinical Data

Check the symptom (s) you have presented. If you have not had any of the above symptoms, check only the final option "I have not had symptoms"

Symptom

Sudden onset of symptoms

Fever

Cough

Headache

Dyspnea

Shortness of breath

Irritability

Chest Pain

Shaking Chills

Odynophagia

Painful swallowing

Myalgia

Muscle pain

Asrthralgias

Joint Pain

Anosmia

Loss of smell

Dysgeusia

Loss of taste or bad taste in the mouth

Rhinorrhea

Runny nose

Conjuntivitis

Pink eye

Pool General Condition

Diarrhea

Polypnea

Rapid or panting respiration

Adbominal Pain

Vomit

Cyanosis

Bluish discoloration of the skin

Diabetes

COPD

Asthma

Immunosupression

Hypertension

VIH/HIV/AIDS

Cardiovascular disease

Obesity

Chronic renal insufficiency

Smoking

Epidemiological background