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
Select COVID Symptom (s) your child is experiencing
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
2 digit month, 2 digit day, 4 digit yearDate
Patient 1 Name

First NameLast Name
Patient 2 Name

First NameLast Name
Patient 3 Name

First NameLast Name
Patient or Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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