Beef Island Airport - Patient Registration Powered By Hummingbird Health

General Information

First Name

Middle Initial

Last Name

Please share your contact information. Your email and phone will also be where you will receive an invitation to view your test results.

Mobile Number *

Phone

This number can receive text messages

Email

N/A - Not Applicable

Address 1

Address 2

State/Territory *

Zipcode/Postal Code

City/Estate*

What is your immigration status? *

Additional Demographics

Date of Birth (MM/DD/YYYY)

Race *

Gender *

Ethnicity *

Is the patient a member of one of these groups? *

First responder or Healthcare worker

Congregate facility worker or resident

Hospitality or Transportation worker

In-person school/daycare student or worker

Not part of any listed groups

Other priority group (Please indicate below)

Recent Health Updates

Have you been experiencing any Covid-19 symptoms? *

Yes

No

Have you received the Covid-19 vaccine? *

Yes, I received the vaccine

No, I have not yet received the vaccine