COVID-19 Patient Home Isolation Monitoring Support

2. If you have been instructed by your healthcare provider to isolate at home due to COVID-19 and would like a periodic welfare check by phone with McKinney Fire Department Paramedics, please enter the following information:
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address*
18. Emergency Contact: First Name*
19. Emergency Contact: Last Name*
21. Emergency Contact Phone Number*
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field