Please enable JavaScript in your browser to complete this form.COVID-19 School Testing New School Onboarding Form Please provide as much information as possible in order to help us provide you with an individualized testing program for your students. Thank you!Basic InformationName of District, Organization, or School *Address *Phone *Email *Estimated number of students tested weekly. *Ordering Provider *Please enter the name of your school's ordering provider. This is usually the Medical Director, APRN, or equivalent, as decided by your school or district.Provider NPI *Lookup an NPI number here.Do you have multiple schools within your district or organization? *YesNoNotesPlease use this field to provide information about your school's single location (WiFi, entrance requirements, testing space, etc.)ContactsPrimary Contact *NamePrimary Contact Phone *PhonePrimary Contact Email *EmailPositive Results Contact *NamePositive Results Phone *PhonePositive Results Email *EmailOn-Site Issues Contact *NameOn-Site Issues Phone *PhoneOn-Site Issues Email *EmailSchools within District or OrganizationHow many schools will be testing within your district or organization? Schools: 1 School 1 *School Name *AddressNotesNotes about School Location (WiFi, entrance requirements, testing space, etc.)School 2 *School Name *AddressNotes (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 3 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 4 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 5 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 6 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 7 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 8 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 9 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 10 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 11 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 12 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 13 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 14 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 15 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 16 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 17 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 18 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 19 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)School 20 *School Name *AddressNotes (copy) (copy)Notes about School Location (WiFi, entrance requirements, testing space, etc.)Submit
