You can always press Enter⏎ to continue
Hi there, please fill out and submit this form.
3Questions
Registration Form
Language
  • English (US)
  • Español
  • Arabic‬‎
  • Chinese
  • Haitian Creole
  • Português
  • Vietnamese
  • 1
    Press
    Enter
  • 2

    Great, now that you're enrolled, let's get started:
    1. Fill out this form with the information on the person being tested
    2. Write clearly - full last name and first name (no nicknames) and DOB on the tube (MM/DD/YYYY).
    3. For saliva: Spit in the tube, discard funnel, and close the cap tightly
    4. For nasal swab: Swab each nostril, place the swab inside the tube, break the handle at the mark and close the cap tightly.

    Press
    Enter
  • 3

    Please click submit to enroll now.

    Press
    Enter
  • 4
    Press
    Enter
  • 5
    -
    Pick a Date
    Press
    Enter
  • 6
    Press
    Enter
  • 7
    Enter characters found below the barcode on the collection tube:
    Press
    Enter
  • 8
    Press
    Enter
  • 9
    Press
    Enter
  • 10
    Press
    Enter
  • 11
    Press
    Enter
  • 12
    Press
    Enter
  • 13
    Press
    Enter
  • 14
    Enter characters found below the barcode on the collection tube:
    Press
    Enter
  • Should be Empty:
Question Label
1 of 14See AllGo Back
close