Mobile Testing Requests

This request form is for the purposes of requesting to be a host of the IDPH mobile testing team to perform community COVID-19 testing on a specific date or set of dates at your location (ex. local community center, place of worship, company parking lot). This form is not needed to register for individual COVID-19 testing, as IDPH does not require registration for testing. If you are an individual looking to be tested for COVID-19, please visit dph.illinois.gov/testing and enter your address to find the sites nearest to you. Snow and ice removal is the responsibility of each mobile site host. Plowing and salting of the lot/venue should be completed prior to the arrival of the vendor or as soon as possible due to inclement weather.

Mobile Testing Population Size*

Please select which event track you'd like to register for. Small - to serve a populations not to exceed 100 Tests Medium - to serve a populations to serve a population of between 101 - 500 tests Large - Populations of higher than 500 tests to be given.

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You may select more than one if necessary from the list below.

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Please list community partners that could help with advertising the event.

e.g., at a busy intersection, easily identifiable location such as a school or mall.

e.g., near a bus stop, easy for residents to walk to.

Please let us know if the proposed site will be close to any other testing sites or locations by selecting yes or no below.

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Please enter the contact for the location here if it is different from the person submitting the form.

If this is a facility please select yes from the drop down so that our mobile team knows that they are testing an entire facility.

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If the Mobile team has been at this location in the past select yes.

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