CENTRAL ARKANSAS COVID-19 DRIVE THRU TESTING

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* 1. Name (Last, First, Middle Initial)

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* 2. Date of Birth? (MM/DD/YYYY)

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* 3. Current Address (No P.O. Boxes)

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* 4. Cellphone number

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* 5. Testing Location (select one)

Faulkner County Health Unit (811 North Creek, Conway, AR 72032)

Pulaski County Health Unit (3915 West 8th Street, Little Rock, AR 72204)