Request an Appointment Form

COVID Rapid Test Appointment Request

Abbott BinaxNOW COVID-19 Ag Card
Please complete the form below to register online for COVID-19 testing.
- I voluntarily agree for myself/or child to be tested for COVID-19.
- I have read and signed the COVID-19 Screening Consent Form.
You can register up to 3 children per time slot. If more tests are required, please fill out a second form.
- Middle School - please sign up for appointments 07:30 or later
- 2nd-4th Grade - please sign up for appointments 07:45 or later
- Robin Hall - please sign up for appointments 08:00 or later
- Preschool - please sign up for appointments 08:15 or later
Reason for Requesting Appointment*
Is the patient experiencing symptoms of COVID-19*

YesNo
Select COVID Symptom (s) your child is experiencing*

Fever (>100.4F) and/or chillsCough (new, changed, or worsening)Congestion/runny noseFatigueHeadacheSore ThroatNausea, vomiting, or diarrhea (last episode must be at least 24 hours before returning to school)
If patient is experiencing symptoms of COVID-19, they are not eligble to participate in the "Test to Stay" protocol. If you have any questions or concerns, please contact the school nurse.
If close contact, Date of last exposure.

MonthDayYear
Date
Patient 1 Name*

First NameLast Name
Patient 2 Name

First NameLast Name
Patient 3 Name

First NameLast Name
Patient or Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Name of Parent/Guardian if consenting for minor(s)

First NameLast Name
Select an Appointment Date
Email
For appointment confirmation
Should be Empty:

COVID Rapid Test Appointment Request