Cypress School District Testing

Cypress School District Testing

Students & Staff
Reminder When You Come For Testing You Will Need The Following:

• 2-copies of Xpress Urgent Care District Student Permission
• 1-copy of COVID History Form
• 2-copies of medical insurance card (front and back)
• 2-copies of driver’s license or other identification card (front only)
Person Being Tested *

First Name Last Name
Date of Birth *
00/00/0000
Phone Number *

Area Code Phone Number
Email *
example@example.com
Birth Sex
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do You Have Health Insurance? *
Medical Insurance Name *
(Anthem, Blue Shield, Kaiser, HealthNet, Etc.)
Medical Insurance Number *
Medical Group Name *
(Monarch, Prospect, Healthcare Partners, Etc.)
Medical Group Number *
(IF NO GROUP NUMBER, TYPE IN 0)
Testing Schedule Locations & Times

Every Wednesday 2:00 PM - 4:00 PM

Locations: Cypress School District Testing

District office 9470 Moddy St, Cypress

PLEASE SCHEDULE YOUR TIME AT THE APPROPRIATE LOCATION & TIME.
Appointment *
Should be Empty: