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Cumberland City COVID Testing Sign-ups
Please complete all required fields to sign up for COVID Testing
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* Indicates required question
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Your answer
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Your answer
First Name
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Your answer
Last Name
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Your answer
Phone Number - Please make sure this is a working number - this number will be used to report all POSITIVE results. (Note - for minors, please use parent/guardian's phone number)
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Your answer
Date of Birth
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MM
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DD
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YYYY
Gender
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Female
Male
Street Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Ethnicity
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Hispanic
Not Hispanic
Unknown
Result Preference: Please either provide your cell or email for receiving a text for negative results. All positives will be a phone call.
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Your answer
Testing Date Registration - please pick 1
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12/8/2020 from 9 - 11 am
12/9/2020 from 9 - 11 am
Have you tested positive in the past 90 days?
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Yes
No
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