COVID-19 Appointment Request Entries Covid-19 Testing Form - Duplicate If you are human, leave this field blank. user ID entry ID Submitted Date Total Count First Name Last Name Date of Birth Phone Email * Age Do you agree to have your results given to you by telephone and text? Yes No Appointment Date/Time * Thursday, June 18, 2020, 9:00 AM - 12:00 PM Thursday, June 18, 2020, 12:00 PM -3:00 PM Friday, June 19, 2020, 9:00 AM - 12:00 PM Friday, June 19, 2020, 12:00 PM -3:00 PM Submit