Cedar Care COVID Test Scheduling
This appointment is for a TEST and NOT VACCINATION
Appointment
I agree that I am scheduling an appointment for a COVID rapid antigen test and not a COVID vaccine
*
I agree
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Birthday
-
Month
-
Day
Year
Date
Are you having COVID symptoms (cough, loss of smell or taste, fever, chills, body ache or loss of appetite)?
Yes
No
Have you been exposed to someone who tested positive for COVID in the last 10 days?
Yes
No
Not Sure
Do you live, work, or go to school in the village of Cedarville?
Yes
No
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm