113 W Sycamore Street, Attica, IN 47918
(877) 339-9567
(765) 762-3035
Search for:
Home
Services
Coronavirus Disease
Complaints & Spills
Environmental Health
Food Safety
Health Education
Immunizations
Nursing Services
Septic Systems
Vital Records
Preparedness
Community Resources
News
Opioid Awareness
Contact
Application for Testing
Name of Contact
*
First
Last
Contact Phone
*
Contact Email
*
Name of ILL Person
*
First
Last
Address of ILL Person
*
Street Address
Address Line 2
City
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Age of ILL Person?
*
Please enter a number from
1
to
99
.
Workplace of ILL Person?
Do you have other chronic medical problems such as heart or lung disease, cancer, a weak immune system, or other high risk conditions?
*
Yes
No
How Many Days Sick?
*
Please enter a number from
1
to
99
.
Fever over 100.5?
*
Yes
No
Cough?
*
Yes
No
Suspected COVID-19 Contact?
*
Yes
No
I have insurance
*
Yes
No
CAPTCHA
Home
Services
Coronavirus Disease
Complaints & Spills
Environmental Health
Food Safety
Health Education
Immunizations
Nursing Services
Septic Systems
Vital Records
Preparedness
Community Resources
News
Opioid Awareness
Contact
Skip to content
Open toolbar
Accessibility Tools
Increase Text
Decrease Text
Grayscale
High Contrast
Negative Contrast
Light Background
Links Underline
Readable Font
Reset
