Testing Appointment Form
COVID-19 Testing
Patient Name
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First Name
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I may have been exposed to COVID, and want a test
I have cold/flu symptoms
I'm traveling and need a COVID test
I'm having surgery and need a COVID test
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example@example.com
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Covid 19 PCR TEST $150 (20% discount)
$
120.00
This is a molecular in vitro diagnostic test utilizing reverse transcription-polymerase chain reaction (RT-PCR) and lateral flow technologies for the qualitative, visual detection of the coronavirus SARS-CoV-2 viral RNA. Nasal swab, inserted in each nostril, then analyzed onsite. Results back in 30 minutes. $150 is collected at time of test. You may submit to your insurance for reimbursement - Check with your insurance first.
FLU A + B + Covid 19 Rapid Antigen Test: $100 (20% discount)
$
80.00
(COVERED By MEDICARE) This antigen test tells whether you have active infection or not. Nasal swab, inserted 1", then analyzed onsite. Results back in 15 minutes-20minutes .$100 is collected at time of test. You may submit to your insurance for reimbursement - check with your insurance first.
Total
$
0.00
Please verify that you are human
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