At-Home Test Form
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Which test are you taking?*
Org, Employer, school or entity test is for?:*
Date of Birth:*
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What was your Test Result?*
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Self - 18 or older
UNDER 18 - Parent or Guardian Consent
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By checking this box and submitting your test result, you are attesting and confirming that you are 18 years of age or older and that this test was self administered on the date of submission.
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