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.
Invalid primary identifcation upload type.
Please upload a PNG, PDF or JPG.
Invalid alternate form upload type. Please
upload a PNG, PDF or JPG.
Registering on behalf ofEnter the required information for the child or adult on whose behalf you are registering. Do not enter your information below.
Date of Birth
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.