Frostburg City COVID Testing Sign-ups
Please complete all required fields to sign up employees for COVID Testing 2
Name of Business *
Business Contact Name *
Business Contact Cell *
Business Contact Email *
Employee's First Name *
Employee's Last Name *
Employee's Date of Birth *
MM
/
DD
/
YYYY
Employee's Gender *
Employee's Street Address *
Employee's City *
Employee's State *
Employee's Zip Code *
Employee's Ethnicity *
Phone number *
Have you tested positive in the past 90 days? *
Employee's 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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