Testing Appointment Request
If you need a SAME DAY appointment, we recommend calling 716-852-7743 or the Pride Center is open for walk-in testing and testing by appointment at the following times: Monday 9:00am-5:00pm, Tuesday 11:00am-2:00pm & 3:00pm-7:00pm, Wednesday 100:00am-1:30pm & 2:30-6:00pm, Thursday 9:00am-5:00pm and Friday 9:00am-5:00pm. The last testing appointment is set 30 minutes before the building closes.
Name
*
First Name
Last Name
Affirmed/Preferred Name
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date
My pronouns are:
They/Them
She/Her
He/Him
Other
Have you been tested at the Pride Center before
*
Yes
No
Unsure
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
What days work best for you
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time works best for you?
*
Morning
Afternoon
Evening
Any specific date/time?
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
I will need the following accommodations in order to participate:
American Sign Language (ASL) Interpreter
Wheelchair access
Large print forms
Other
To confirm or reschedule my appointment, please contact me by:
*
Email
Phone Call
Text Message
Submit
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