On Site Testing (James St.) First Name Last Name Company (if applicable) I authorize HealthBar to release results to my employer for testing completed today Your email Phone Number Date of Birth Please use format: MM/DD/YYYY (Including forward slash /) Gender —Please choose an option—FemaleMalePrefer not to answer Race —Please choose an option—White/CaucasianAsianBlack or African AmericanNative American Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderOtherUnknown Ethnicity —Please choose an option—HispanicNon-HispanicUnknown Symptoms/Exposure —Please choose an option—I don't know if I was exposed to COVID-19 and I don't have symptoms.I don't know if I was exposed to COVID-19 but I have symptoms.I was exposed to COVID-19 but I don't have any symptoms.I was exposed to COVID and I have symptoms. Test Requested —Please choose an option—Rapid Antigen TestLab PCR TestSaliva TestAntibody TestAditxtScore-COVID-19 Immunity Test Testing Location —Please choose an option—Appointment LaneBay 1Bay 2Bay 3Remote Testing