COVID-19 Survey

I understand that this is a drive-through service only, for the safety of test site personnel, anyone walking to the test site will not be tested.
Email Address
(We will send you an email to confirm the address is valid)

Are you over 18 years of age?

Are you a resident of Burlington County NJ or a non-resident employee working in Burlington County NJ?

Are you registering on behalf of a family member under the age of 13 or an individual that is currently under your care:

You are not eligible for this program.

For additional information, or if you are sick, please contact your health care provider or visit the Burlington County Department of Health COVID Testing page for more information.



Based on your report, you are not eligible for a mail-in test through this program.

For additional information, or if you are sick, please contact your health care provider or visit the Burlington County Department of Health COVID Testing page for more information.

  • Step 1 - Personal Information
    Example - K55554444433333
    Non-resident students use your permanent home address and upload school ID.
    If registering on behalf of others, caregivers and social workers use business address and upload work ID.
    This is NOT a required question. The question is to provide health professionals and researchers with data to combat Covid-19.

    Please upload a valid driver's license or two alternate forms of identification. You may provide either a PDF or JPEG (image file). The image must be clear.

    Registering on behalf of

    Enter the required information for the child or adult on whose behalf you are registering. Do not enter your information below.
    Date of Birth

    Please upload a school ID, birth certificate, library card, passport, immigrant visa, permanent resident green card or other government ID

    By clicking the submit button below you confirm that the information you provided is accurate and up-to-date. HomeCovidTest.org is not responsible for a delay or hardship due to circumstances that are beyond the control of the Health Department.

  • Screening Questions

    Do you work in any of the following settings: clinic, hospital, nursing home, senior care facility or first responder?
    Even if you are not a doctor or nurse, if you work in one of these locations please select 'yes.'

    Do you currently have any of the following symptoms? Select all that apply:

    In general, do you currently have any health conditions that you manage (such as diabetes, asthma, or high blood pressure)?

    By clicking the submit button below you confirm that the information you provided is accurate and up-to-date. HomeCovidTest.org is not responsible for a delay or hardship due to circumstances that are beyond the control of the Health Department.

Protection

Older adults and people who have severe underlying chronic medical conditions such as heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. Please consult with your health care provider about additional steps you may be able to take to protect yourself.

Prevention

If you are sick with COVID-19 or think you might have it, follow the steps below to help protect other people in your home and community.

Community Toolkit

Join the fight against COVID-19 in New Jersey by sharing the following materials across your social media channels, websites, newsletters, and more. Learn more about COVID Alert NJ and download the app here.

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