COVID-19 Testing Appointment Form

Testing will be done Monday, Tuesday, and Thursday from 9 am-Noon unless otherwise noted on the schedule below.

Test results will be called to you when they are received by staff, please wait for their call.

Return times vary most results will be back in 48 hours.

We do have special kits (when available) for K-12 students and staff.

WE WILL NOT DO RETESTS OR TESTS TO GO BACK TO WORK/SCHOOL!

If you are requesting a test for a procedure, the cost is $50.00.

If you are requesting a test for travel, the cost is $75.00.

Attention: Please enter through the NORTH/SIDE door that is marked COVID TESTING.

Call once you arrive: 816-586-2311 and we will meet you at the door. Please wear a mask.

Have you been tested here before?* This field is required.

YESNO

When was your last test?* This field is required.

Why are you requesting a test?* This field is required.We will not to retests or tests to return to school/work!!

Symptomatic

Medical procedure

Travel

Are you a.....

Elementary, Middle, or High School student

Elementary, Middle, or High School teacher/staff

Which school

School

Are you currently experiencing any symptoms?* This field is required.

Fever/Chills

Fatigue

Cough

Headache

Difficulty breathing

Loss of taste and/or smell

Body aches

Nasal congestion

Runny nose

Sore throat

GI symptoms

None

Date symptoms began* This field is required.

Date

Schedule Appointment* This field is required.

Name* This field is required.

First Name

Last Name

Date of Birth* This field is required.

Date

EmailResults will be emailed to this address.

Address* This field is required.

Street Address

County

City

State / Province

Postal / Zip Code

Country

Phone Number* This field is required.

Area Code

Phone Number

Insurance* This field is required.

Insurance Provider

Insured Name and DOB

ID Number

Group Number

COVID-19 Testing Appointment Form