Monroe County, NY COVID-19 Testing Registration Form

PRE-REGISTRATION ENCOURAGED!
WALK-INS WELCOME.

* Required Fields

Your email Address *

Confirmation of appointment will be sent to this email.

Pick a Testing Site

How Are You Arriving? NOTE: This changes what is available in the calendar.

Drive Through (Irondequoit) Park & Walk Up (All Other Locations)

# People in Group: Max: 4

Pick a Date *

Available date/time Unavailable Selected

Person

First Name *

Last Name *

Middle Name

Date of Birth *

Race *

Ethnicity *

Gender *

Email * Copy From Top Email

This email address will receive notification of test result.

Address * Copy From Person #1

Address (Line 2, Apt, Etc.)

City *

State *

Zip *

Special Accommodations

If this person needs special accommodations please indicate above.

Job Title or "Student"

Employer Name or School District

Phone

Employer Street Address or School Name

Employer or School City

State

Zip

YOU WILL NOT BE ABLE TO EDIT THIS INFORMATION AFTER CLICKING THE SUBMIT BUTTON BELOW. PLEASE MAKE SURE ALL INFORMATION IS CORRECT.