SHELL HEALTH

COVID-19 Test Registration

Complete the form below to register for a COVID-19 rapid test.

All COVID testing is done at your vehicle. Please completely fill out the form below. After submitting, you will receive an email with further instructions. Result are provided via email email unless otherwise requested. You must register register the same day you intend to be tested.

COVID testing is subject to limited availability and you are not guaranteed a test if you register.

Legal First Name

Legal Last Name

Chosen First Name

Chosen Last Name

Phone

Birthday

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Color

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Check all that apply:

I need a COVID-19 test to return to Work/School/Daycare or to travel

I HAVE been exposed to someone who has tested positive for COVID-19 in the last 10 days

I HAVE NOT been exposed to someone who has tested positive for COVID-19 in the last 10 days

I AM NOT experiencing symptoms of COVID-19

I AM experiencing symptoms of COVID-19

I have recently traveled to a location witha CDC Travel Advisory

Vaccination Status

I declare that the info I’ve provided is accurate & complete

Initials

Date

Thanks for submitting! Check your Email!

COVID-19 Testing Hours

Monday: 11am to 3pm

Tuesday: 11am to 3pm

Wednesday: 11am to 3pm

Thursday: 11am to 3pm

Friday: 11am to 3pm

4321 Downtowner Loop N,

Mobile, AL 36609

251-289-0638

chance@shellhealth.org