Language
  • English (US)
  • Spanish (Latin America)
  • HIPAA Release

  • By signing in the box below I am stating the following: "I authorize and request that my COVID Test results be disclosed to, and used by, appropriate WesternU officials, including but not limited to appropriate officials in the WesternU’s Student Employee Health Office, in order to encourage a safe campus, workplace, and learning environment, and to enhance the safety of WesternU’s students, employees, and visitors"

    This HIPAA Release is valid for 1 year from the date of submission of this form.

  •  -  - Pick a Date
  • Clear
  • COVID-19 Testing

    You will be required to present your Drivers license or Picture ID at the time of test.
  • Health

  •  -  - Pick a Date
  • Travel and Exposure

  • Home and Employment

  • Congratulations! 

    Your test will be FREE to you.

  • You DO NOT Qualify for Free Testing

    Based on your answer choices it looks like you will not qualify for Free COVID Testing. Currently only credit or debt card payments are acceptable at our facilities for your safety and ours. 

    If you feel this is in error or would like to make a correction to your selection above please do so now before continuing. 

    Thank you.

  • By signing in the box below I am stating the following: I understand that my personal information and test results will be shared with my state’s Department of Public Health.  I understand if the person being tested is under 18 years old, a parent or guardian must be present at testing and consent to the testing. I understand that the results of the COVID-19 rt-PCR nasal swab test should be correlated with clinical symptoms and discussed with my medical professional. I understand that a negative result does not exclude the possibility of infection, however, it just indicates that the collected sample is negative. I consent to being tested by Trilab Health (CLIA ID:14D2096036) and confirm that I am at least eighteen years of age or signing for a minor under the age of eighteen. I acknowledge that I have the authority to assign to Trilab the right to bill and collect from any health insurance plan that I may have. I assign the right for Trilab to bill and collect from my health insurance plan that covers any physicians, caregivers, or other providers of services who are not employed by Trilab and whose services will be billed separately for all services provided.

  • Clear
  • Should be Empty: