Book Appointment – COVID-19 Virtual Follow Up

Please provide the following information to schedule a virtual follow-up appointment regarding your recent COVID-19 test. A representative will contact you within 1-2 business days to confirm your appointment. To best prepare for your virtual appointment, click here for our virtual appointment resource guide.
Name * Required
First Last
Date of Birth * Required
MM slash DD slash YYYY
Phone Number * Required
Email Address * Required
Health Insurance Carrier
COVID-19 Test Date
What date were you tested for COVID-19?
MM slash DD slash YYYY
COVID-19 Results Date
What date did you receive the results for the COVID-19 test?
MM slash DD slash YYYY
Test Results * Required
- Positive
- Negative
Appointment Request Information
Information entered on this form is intended for WPH care teams to help secure follow-up appointments for patients recently tested for COVID-19. The information is kept strictly confidential. If you would feel more comfortable speaking with our Navigator, please call 914-849-MyMD (6963) and mention “virtual follow up appointments for COVID19 testing”. If you are experiencing a medical emergency, please call 9-1-1.