Monroe County, NY COVID-19 Testing Registration Form

PCR Testing for K-12 Students, Teachers and School Staff Only
FLEET Building 11 Only Open M-F 9AM-12PM
(Closed Afternoons)

To use this PCR test registration form, individual must be:

Not under official quarantine by Monroe County Department of Public Health
Symptom and fever free for 24 hours without fever reducing medication
Enrolled in or employed at a K-12 school

Bring proof of eligibility with you to appointment! Students must be accompanied by a parent or guardian 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).

Testing is drive through. Do not leave your vehicle.

* Required Fields

Your email Address *

Confirmation of appointment will be sent to this email.

Pick a Testing Site

# 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.