EmailMeForm
12/22 Town of Amherst COVID Testing Registration
This testing is for a Town of Amherst Resident or Town of Amherst Employee who requires testing not accepted at the Umass asymptomatic test site
December 22, 2020 Testing
1 pm - 3 pm
Testing Location
Mill River Recreation Area
95 Montage Rd.
Amherst, MA 01002
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Please select time slot
1:45 pm
2:00 pm
2:15 pm
2:30 pm
2:45 pm
Testing is scheduled in 15 min blocks to reduce waiting time. Please arrive at your selected time and we will test you as soon as possible.
Name
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First
Last
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Please select
Female
Male
Race
*
Please select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other Race
Unknown
Ethnicity
*
Please select
Hispanic or Latino
Not Hispanic or Latino
Unknown
Home Address (No PO Boxes)
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Home Phone (if no home phone, put cell number if available)
*
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Email
This email will be used to notify you of test result
Confirm
Cell Phone
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City Department
*
If school dept. please also add school you work
Attestation
I attest I am a Town of Amherst Resident or Town of Amherst Employee who requires testing not accepted at the Umass asymptomatic test site
