COVID-19 Test Screening - May 27, 2020
IMPORTANT INSTRUCTIONS FOR TESTING, PLEASE READ: Please complete the screening tool below to pre-register for testing at our walk up clinic in Hudson on May 27, 2020. Please provide a telephone number where you can be reached at the end of this form, so that the Columbia County Department of Health (CCDOH) can contact you for further information necessary for registration. You will be expected to quarantine until your test results are received, at which time you will be contacted by CCDOH with those results and for further guidance. Please also note that this test will be in the form of a nasopharyngeal swab and is not an antibody test.

Pre-registration is not necessary for testing on this date, but it will guarantee you a spot. If you do not register ahead of time, we cannot guarantee that you will be tested at this clinic.

Please be aware that by filling out this form you are providing voluntary consent to testing.
Email address *
Are you experiencing any of the symptoms associated with the COVID-19 illness (fever, shortness of breath or difficulty breathing, sore throat, chills, new loss of taste or smell, headache, cough)? *
If you answered yes to the question above, please describe your symptoms below:
Your answer
If you are experiencing symptoms, please note below the date they began.
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To your knowledge, have you been in contact with an individual who has tested positive for COVID-19? *
If you answered yes to the above question, has it been at least three days since you were exposed to the individual who tested positive?
Are you currently employed as a healthcare worker (nursing home, hospital, or other medical facility)? *
Are you currently active or employed as a first responder (firefighter, EMT, paramedic, law enforcement officer)? *
If yes to above, list first responder title.
Your answer
Which county do you currently reside in? *
Your answer
Do you work in Columbia County? *
First Name *
Your answer
Last Name *
Your answer
Physical address *
Your answer
Mailing address (if different from above)
Your answer
Date of Birth *
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By filling out this form you are providing voluntary consent to testing. PLEASE PROVIDE A TELEPHONE NUMBER where you can be reached for further information and to complete the registration process. Please bring a valid photo id with you to your appointment. *
Your answer
Check below if we can contact you via email to complete registration.
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