CALL US: (603) 536-1120

COVID-19 Test Request Form

This form is to request an appointment and provide consent for COVID-19 testing at Speare Memorial Hospital. Your information will be kept confidential and only used for scheduling, diagnostic, tracking, and billing purposes. By completing this form you are voluntarily sharing this information. Information on this form may be shared with the New Hampshire Division of Public Health Services for public health purposes.

Translate »
Scroll to Top