Monroe County, NY COVID-19 Testing Registration Form

PRE-REGISTRATION ENCOURAGED! WALK-INS WELCOME.

Children under 1 year old are ineligible to receive a test at our facilities.
Individuals under 18 MUST have a parent/legal guardian with them to consent in person with acceptable ID - Driver's ID, Passport, State Non-Driver's ID, Medicaid Card (with photo), School ID (with photo), or Work ID (with photo).

* 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: 7

Pick a Date *

Available date/time Unavailable Selected

Pick a Time *

Person

Delete This Person

First Name *

Last Name *

Middle Name

Date of Birth *

Race *

Ethnicity *

Gender *

Phone * Copy From Person #1

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.

School/Employer Info

Job Title or "Student"

Employer Name or School District

Phone

Employer Street Address or School Name

Employer or School City

State

Zip

Add Another Person

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