Testing Appointment Form

1

Testing will be done Monday-Thursday from 9 am-Noon unless otherwise noted on the schedule below.

Test results will be called to you when they are received by staff, please wait for their call.

Return times vary most results will be back in 24-48 hours.

We do have special kits (when available) for K-12 students and staff.

WE WILL NOT DO RETESTS OR TESTS TO GO BACK TO WORK/SCHOOL!

2

Why are you requesting a test?* This field is required.

Symptomatic

Medical procedure

Travel

3

Are you a.....

Elementary, Middle, or High School student

Elementary, Middle, or High School teacher/staff

4

Which school

School

6

Date symptoms began* This field is required.

Date

7

Schedule Appointment* This field is required.

8

Name* This field is required.

First Name

Last Name

9

Date of Birth* This field is required.

Date

10

Email

11

Address* This field is required.

Street Address

County

City

State / Province

Postal / Zip Code

Country

12

Phone Number* This field is required.

Area Code

Phone Number