COVID-19 Testing Appointment Form

Testing will be done by appointment ONLY.

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 24 hours.

Covid tests for symptomatic individuals are free

Strep test - $10

Influenza A & B - $10

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 $25.00.

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

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 in the last 3 months?* This field is required.

YESNO

What test are you requesting?* This field is required.

COVID-19 - Free

Flu A&B - $10

Strep - $10

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 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

Date of Birth* This field is required.

Date

Gender* This field is required.

Male

Female

Ethnicity* This field is required.

Hispanic

Non-Hispanic

Race* This field is required.

American Indian

Asian

Black

Pacific Islander

White

Other

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

COVID-19 Testing Appointment Form