TESTING

SECTION 1: TESTING OPTIONS

Home rapid Covid antigen test kits are available in store: $24.56 (tax included) for 2 test

What test would you like to receive?*

Rapid Covid Antigen - $40 - Results in 15 minutesRapid Flu test - $40 - Results in 15 minutesRapid Strep Throat - $40 - Results in 7 minutes (Age 6+)Rapid RSV Antigen- $30 - Results in 15 minutes (Age 5+)Rapid HIV - Free - Results in 5 minutes

Summary of tests are listed on bottom of page.

ALL TESTS ARE CLIA APPROVED

Influenza:

Scott Pharmacy has started providing necessary influenza test to patients in a safe and convenient setting in order to ensure appropriate and timely antiviral therapy is started for patients with a poistive influenza test.

IMPORTANT INFO

If positive, to be eligible for influenza treatment:

Must be 6 years or older
Must have flu-like symptoms
Onset of symptoms within the last 48 hours

List of treatment exclusion criteria on bottom of form

Strep Throat

Scott Pharmacy has started providing necessary strep test to patients in a safe and convenient setting in orderto ensure appropriate antibiotic therapy is started for patients with a poistive Group A Streptococcal strep throat test.

IMPORTANT INFO

If positive, to be eligible for strep throat treatment:

Must be 6 years or older
Must have strep throat symptoms
Onset of symptoms within the last 48 hours

List of treatment exclusion criteria on bottom of form

How many people will be tested in your vehicle? PLEASE STILL REGISTER EACH PERSON. Thank you!*

1234+

Is this COVID test being used for travel requirements?*

Scott Pharmacy offers at home test kits and two different supplemental vitamin packs to help boost the immune system. Please select below if you would like a supplemental pack or an at home covid-19 test. TAX INCLUDED. ***MAY SKIP IF NOT INTERESTED***

$20 - Complete 2 week supplement pack. This pack includes: Vitamin D, Magnesium oxide, NAC, Vitamin C, and Zinc.$30 - ***2*** Complete 2 week supplement packs. This pack includes: Vitamin D, Magnesium oxide, NAC, Vitamin C, and Zinc.$10.65 - 5 day EZC Pak. This herbal pack includes: Vitamin C, Zinc, and Echinacea root.$24.56 - At Home Covid-19 test (2 test per box)

SECTION 2: DEMOGRAPHICS

Name:*

First NameLast Name

Date of Birth:*

Phone Number:*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Gender:*

Email

example@example.com

SECTION 3: SCHEDULING

Appointment*

SECTION 4: IMPORTANT INFORMATION

All testing will be in the Scott Pharmacy parking lot. Unfortunately these tests are not covered by insurances. The pharmacy can accept cash or credit card for payment at the time of the appointment. For rapid antigen testing and rapid PCR the pharmacy will provide a printed confirmation of the results.

WHEN COVID TESTING FOR TRAVEL: Please verify if rapid antigen OR rapid PCR is required.

Rapid Covid antigen testing: Nasal viral test to detect COVID-19. Our antigen testing has a near 100% specificity, 92.6% sensitivity for symptomatic individuals, and 78.6% sensitivty for asymptomatic individuals. Antigen tests are an important tool in an overall community testing strategy to reduce transmission.

Rapid Covid antibody testing: Finger stick blood test to detect antibodies related to COVID-19. Results will show if you have had an immune response to COVID and/or COVID vaccine.

Rapid Covid PCR: Nasal viral test to detect COVID-19, RNA. Near 100% specificity and 100% sensitivity.

Rapid Covid antigen/Influenza: Nasopharyngeal swab (3 inches) in one nostril to detect COVID-19 or Influenza Type A/B.

Rapid Strep A test: Throat swab to detect Group A Streptococcus bacteria.

Rapid RSV: Nasopharyngeal swab (3 inches) in one nostril to detect RSV antigen.

Rapid HIV: Finger stick blood test to detect antibodies related to HIV-1/HIV-2.

DISCLAIMER: Please understand that no third-party reimbursement, including Medicare or Medicaid reimbursement, will be submitted for this test. There are other testing locations which offer free tests, and testing which is covered by Medicare and Medicaid. However, at this location, no third-party reimbursement will be sought, and the above patient agrees to pay out of pocket for the cost of the test.

FLU TREATMENT EXCLUSIONS: Immunocompromised, taking steroid for longer than 2 weeks, been prescribed an antiviral for influenza in the last 14 days, have a medical condition that requires supplemental oxygen therapy, known hyersensitivity to tamiflu/xofluza, women who are pregnant or breastfeeding, and/or patients less than 19 who are on long-term aspirin therapy.

STREP TREATMENT EXCLUSIONS: Immunocompromised, taking steroid for longer than 2 weeks, been prescribed an antibiotic for sore throat/respiratory infection in the last 30 days, have a medical history of rheumatic fever/rheumatic heart disease/scarlet fever/GAS-inducted glomerulonephritis, known hyersensitivity to certain antibiotics (amoxicillin/cephalexin), and women who are pregnant or breastfeeding.