Concierge Covid Testing

Concierge Testing Intake Form

Please use this form if you would like us to come to your area of residence, facility or business to carry out same day testing. Please note our facility is Fully CLIA Certified which means we have a special license to do Point of Care Testing. If you would like to learn more please visit us at www.covidexpresscare.com, any questions please email us at covidexpresscare@gmail.com. After you fill out this form, we will reach out to you within a few hours.
Name *

First Name Last Name
Birth Date *

Month Day Year
Email: *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Choose your Test Date & Time (Please note our provider will be there in a two hour time block, and will let you know in advance their Estimated Time of Arrival)
Special requests?
Some of our clients live in nursing homes or businesses and they ask for special requests before arriving to the facility.
Testing more people? Just add their full name and date of birth—don’t forget to upload their ID if they have one
Upload your ID so we can get your results form right

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Cancel of
Although we do not accept insurance, most insurance providers will reimburse you for the cost of your test. We will provide you with a receipt for your test, which you can provide to your insurance company for possible reimbursement. While we cannot guarantee such reimbursement, typically insurance companies will provide some reimbursement for COVID testing which they will pay directly to the patients. Each insurance company's policy on reimbursement is different, and may reimburse different amounts for the cost of the test. We will provide you with the needed receipt on-site at the time of your test.
Sign here to get tested ASAP, please note once you submit this form our representative will call you to confirm your appointment.

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Concierge Testing Intake Form

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