COVID-19 Rapid Antigen Test + Appt

Point-of-Care Testing Appointments

* Please fill out the required details below. We offer antigen testing for current infection. All testing is conducted curbside at 38th Street Pharmacy at 711 W 38th Street C-3 Austin, TX 78705.
Section I. Personal Information
Patient's Full Name*

FirstName LastName
Date of Birth:*

MonthDay Year
Age:*
Patient Cell Phone Number*
Please enter a valid phone number. Only enter numbers no () or dashes.
Primary Phone Number*
Please enter a valid phone number. Only enter numbers no () or dashes.
Address*

AddressOne

AddressTwo

City StateCode

Zip Country
Email*
example@example.com
Gender at birth: (M: Male, F: Female, U: Other)*

MFU
Ethnicity:*

Hispanic or LatinoNot Hispanic or LatinoUnknown
Race:*

Black or African AmericanAmerican Indian or Alaska NativeAsianWhiteNative Hawaiian or Other Pacific IslanderOther
County you live in (for example Travis, Hays, etc.)*
CountyOfResidence
Which rapid test would you like to receive?*

COVID-19 Rapid Antigen Test ($65.00)Flu A + B Rapid Test ($45.00)
Section II. Appointment Scheduler
Please pick a day and time for your COVID-19 test:*
Section III. Signatures

I hereby give my consent to 38th Street Pharmacy to receive a COVID-19 and/or Flu test. I understand that no test is 100% accurate, and there is a chance that the results may not accurately reflect my infection status. I am expected to arrive on time to my appointment, and I understand that my test may not be rescheduled. I consent to having my results sent via the email provided above.

* I also understand that due to the sensitivity and availability of this test, I am not entitiled to a refund under any circumstance.

If you have questions, please call us at 512-458-3784.

This form is HIPAA compliant and secure. Any and all information you enter will only be viewed by the staff of 38th Street Pharmacy.

*PLEASE REMAIN IN YOUR VEHICLE AND CALL WHEN YOU ARRIVE
Signature of Person to Receive a Rapid Antigen Test*

Clear
By clicking the "Submit" button below, you certify that the above information is correct and accurate to the best of your knowledge. All information is confidential and is accessed only via a secure, encrypted interface.
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Point-of-Care Testing Appointments