COVID-19 Testing Appointment Form

The City of Nashua Division of Public Health and Community Services (DPHCS) is offering free walk-up or drive-thru COVID-19 testing (PCR nasal swab) every Tuesday from 3 to 5 PM at the Elm Street Parking Garage (14 Elm Street, Nashua, NH 03060). Testing is available for anyone who requests a test. Results are returned by phone from 48 to 72 hours after testing.

To register for a test, complete the form below. To register additional people, complete a new form for each person. If you are under 18 years of age, you must be accompanied by a parent/guardian.

Testing Clinics will be cancelled or suspended if the heat index reaches 95 degrees fahrenheit or above, and/or if strong winds, heavy rain, lightening, thunder, or other extreme weather is forecast during the time of scheduled clinics. Our staff will make every attempt to notify those with appointments and those who want to attend clinics of the cancellations.

For additional information or questions, call the Nashua COVID-19 Hotline:

603-589-3456 or visit our website.

Name *

First Name Last Name

Date of Birth *

Date

Age *

Phone Number *

Area Code Phone Number

Sex *

Ethnicity *

Race *

Address *

Street Address

Street Address Line 2

City State

Zip Code

Email

Are you a healthcare worker? *

Yes No

Are you an emergency responder? *

Yes No

Have you been exposed to COVID-19 at work? *

Yes No

Are you pregnant? *

Yes No

Are you experiencing homelessness? *

Yes No

Are you a resident of a group home or in foster care? *

Yes No

Have you been exposed to someone with a confirmed case of COVID-19? *

Yes No

If yes, when was the date of exposure?

Date

Have you recently traveled out of state? *

Yes No

If yes, list date(s) and location?

Do you have a vehicle available to drive to the testing site? *

Are you currently experiencing any of the following symptoms of COVID-19? *

Schedule Your Appointment *

Is there anything other information you wish to provide before your testing appointment?

We look forward to seeing you during the time slot you selected for your testing appointment! Please arrive at the exact time of your appointment. If you have any questions in the meantime, please call 603-589-3456.

Date