Visit Information

Starting February 25, 2021, the drive-through COVID testing at the Sheep Pavilion will be open Monday and Wednesday from 8 am – noon only. Testing will not be available at the Sheep Pavilion outside the new hours.

People with signs and symptoms of the virus should visit the Bothwell Walk In Clinic to be seen by a provider. Clinic hours are 7 a.m. to 7 p.m. Monday - Friday and 10 a.m. to 4 p.m. Saturday. There will be no curbside testing at this location. The Walk In Clinic is located on the first floor of the Healing Arts Center at 3700 W. 10th Street in Sedalia.

Expected COVID Test Date and Approximate Time *

Reason for Test (sore throat, cough, shortness of breath, fever)

Date of Positive COVID Exposure *

Family Physician Name

Patient Information

First Name *

Middle Initial

Last Name *

Date of Birth: (DD/MM/YYYY) *

Sex *

Race *

Ethnicity *

Primary Language *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone Number: (i.e., 555-555-5555) *

Phone Number Type

Home
Cell

Email Address (For signing up and receiving results through our portal.)

Is the Patient currently employed?

Yes
No

(If yes) Employer Name and Address

(If yes) Employer Phone: (i.e., 555-555-5555)

Next of Kin Information

First Name

Middle Initial

Last Name

Address 1

Address 2

City

State

Phone Number (i.e., 555-555-5555)

Email Address

Work Number (i.e., 555-555-5555)

Relation to Patient

Emergency Contact

First Name

Middle Initial

Last Name

Address 1

Address 2

City

State

Phone Number (i.e., 555-555-5555)

Work Number (i.e., 555-555-5555)

Relation to Patient

Insurance Information

Do you currently have insurance?

Yes
No

Insurance Company Name

Policy Number

Group Number

Policy Holder Name

Policy Holder Date of Birth: (DD/MM/YYYY)

Policy Holder Marital Status

Responsible Party Information

Is the Responsible Party the same as the patient?

Yes
No

Is there another Responsible Party?

Yes
No

Additional Comments

Before arrival at the Missouri State Fairgrounds, please call 660-827-7900 to let us know you are on your way. Please email us a copy of your insurance card (front and back) and photo ID (if not already on file) to bwc@brhc.org.