PCR Covid 19 Testing Appointment and Consent Form

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By Signing in the box below I am stating the following:

I understand that my personal information and test results will be shared with the NEW YORK Department of Health.

I understand that the results of the COVID-19 Rapid Antigen/PCR nasal swab test should not be used as the sole determination of the presence or absence of the Covid 19 Virus.

I understand that negative results could be a false negative and that I should confirm the negative result with another lab analyzed high complexity test.

I understand that I am responsible for the payment (s) if not covered by insurance.

I consent to being tested by Professional Pharmacy Facility and confirm that I am at least eighteen years of age or signing for a minor under the age of eighteen.

If a patient does not show up for a previously scheduled appointment, it is considered a “no-show” and the fee will be fully charged.
An appointment cancelled less than 24 hours in advance will be treated
as a no-show.

My Products *

PCR Molecular Test IN 15 Mins ** * * For most Events and travel, Good if collected within 72 hours of event start time

$ 150.00

also want Rapid ANTIGEN Test * * For Events, Good if collected within 6 hours of event start time pursuant to city guidance

$ 120.00

Enter coupon

Total

$ 0.00

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