REFILL PHARMACY Testing Appointment Form

Testing Appointment Form

COVID-19 Testing
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I may have been exposed to COVID, and want a testI have cold/flu symptomsI'm traveling and need a COVID testI'm having surgery and need a COVID test
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example@example.com
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Covid 19 PCR TEST $150.00
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:$100.00
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.

Covid 19 Antibody Test:$45.00
This antibody test tells whether you had COVID in the past, and which antibodies are in your blood. Finger-stick blood drop test. Results in 15 minutes.$45 is collected at time of test. You may submit to your insurance for reimbursement - check with insurance first.

Covid 19 RAPID ANTIGEN TEST (MEDICARE PATIENT ONLY - Will bill through Medicare) $ Free
(NOT MEDICAID - **MEDICARE ONLY**) This antigen test tells whether you have active infection or not. Nasal swab, inserted 1", then analyzed onsite. Results back in 15 minutes.

Total $0.00
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