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COVID Testing Registration Form

Name *

First

Last

Phone *

Please enter a reliable contact number above.

Date of birth *

Please enter your date of birth above.

Date and Time for Appointment *

Date

Time

Please select and day and time for your appointment, the latest we are able to reserve appointments is 3pm.

Information *

Please tell us what symptoms you are currently experiencing

Are you being sent by your employer to get tested? *

Please specify which company is requiring you to get tested *