Lafayette COVID-19 Weekly Testing Appt Scheduling Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Complete this form to request a change to your weekly appointment time.

The testing schedule is below.

Mon, Wed, Fri 7:00AM - 2:30PM (last appointment window between 2:30 and 3)

Tue, Thu 10:00AM - 4:30PM (last appointment window between 4:30 and 5)

You will choose your preferred day of the week and time slot. You will also choose an alternate in case the preferred is not available.

Email *

First Name *

Last Name *

Contact Phone Number: Enter as ###-###-#### *

Choose Your Preferred Appointment Day of the Week *

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms