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Weimar ISD COVID Test Request Form

Leslie Kloesel, RN - WISD District Nurse
lkloesel@weimarisd.org
979-725-6331

This form is for Weimar Independent School District Employees and Students to request on-site COVID-19 testing. If you are not an employee or student of WISD and are seeking testing for COVID-19, you should not use this form.
Please contact your local doctor for testing sites available.

This form must be filled out in it's entirety in order to make the testing process go smoothly.
For questions, please contact Leslie Kloesel, RN.

Campus:

Drivers License Number
First Name
Last Name:
Date of Birth:
Race/Ethnicity: Select all that applies




Other:
Home Address Address, City, County, State, Zip Code must all be provided.
Phone Number
Is this the first test (of any kind) you have had for COVID-19 testing?
IF NO, what type of test have you had before?

IF NO, what is the date of the last test?
Are you having any COVID-19 symptoms?

If yes, you MUST check all symptoms that apply.
















Date Symptoms Started or Direct Contact
Date to be tested: Day, Month/Date/Year
Please select which testing time will work for you.
Jon Wunderlich, Superintendent
Weimar Independent School District
506 West Main Street
Weimar, Texas 78962
Phone: 979.725.9504
Weimar ISD shall be a community nurturing academic excellence for all students and demonstrating leadership in character development. Students’ potential will be maximized in order to grow life-long learners and productive citizens.

Copyright © {{YEAR}} Weimar Independent Schools District. All rights reserved.

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