COVID-19 Portal
Toggle navigation
Sign in
Home
COVID-19 Event Registration
COVID-19 Event Registration
0%
Date of Birth (mm/dd/yyyy) *Please double check your birth year
First Name
Middle Name
Last Name
Suffix
Gender
Male
Female
Unknown
Street 1
Street 2
City
State/Province
Alabama
Alaska
Arizona
Arkansas
California
Canal Zone
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
County
Adams County
Barnes County
Benson County
Billings County
Bottineau County
Bowman County
Burke County
Burleigh County
Cass County
Cavalier County
Dickey County
Divide County
Dunn County
Eddy County
Emmons County
Foster County
Golden Valley County
Grand Forks County
Grant County
Griggs County
Hettinger County
Kidder County
LaMoure County
Logan County
McHenry County
McIntosh County
McKenzie County
McLean County
Mercer County
Morton County
Mountrail County
Nelson County
Oliver County
Pembina County
Pierce County
Ramsey County
Ransom County
Renville County
Richland County
Rolette County
Sargent County
Sheridan County
Sioux County
Slope County
Stark County
Steele County
Stutsman County
Towner County
Traill County
Walsh County
Ward County
Wells County
Williams County
Postal Code
InvitationEvent
Clear lookup field
Launch lookup modal
×
Close
Lookup records
We're sorry, an error has occurred.
There are no records to display.
You don't have permissions to view these records.
Error completing request.
Loading...
×
Close
Error
We're sorry, an error has occurred.
Contact Information
* Please enter at least 1 Telephone number
Home Phone (xxx) xxx xxxx
Mobile Phone (xxx) xxx xxxx
Email
I hereby consent and state my preference to have the State of North Dakota, and its staff, communicate with me by email or standard SMS messaging regarding my COVID-19 test results and any additional relevant medical information. The email address or telephone number I would like to receive SMS messaging at is as provided above.
I understand that email and standard SMS messaging are not confidential methods of communication and may be insecure. I further understand that, because of this, there is a risk that email and standard SMS messaging regarding my test results might be intercepted and read by a third party.
I understand this authorization is voluntary, and the State of North Dakota Community Based Testing Sites may not condition testing on whether I sign this authorization. This authorization remains in effect for five years from the date hereof unless specifically revoked by written notice to the State of North Dakota, except to the extent that action has been taken in reliance on this authorization
I agree to receive my results via Text Message (SMS) or email
I agree to receive my results via Text Message (SMS) or email
No
I agree to receive my results via Text Message (SMS) or email
Yes
Preferred Contact Method for E-Notification
Telephone Call
Email
Text Message
Both