This form is for cash/self-pay patients doing a rapid COVID test only. If you are self-pay, all charges are due at time of visit unless arrangements are made ahead of time with the Clinic. If you want to utilize your insurance to bill for the rapid COVID test, please notify the CMA. In order to utilize insurance for billing, you will be required to attend a brief office visit with a provider. You will also need to fill out a few more documents, which will be sent to you by our CMA after your registration is complete.