You can always press Enter⏎ to continue
COVID PCR RAPID TEST FORM
We provide same day results.  Please complete the questions and schedule your appointment today!  / Proporcionamos resultados el mismo dia.  Por favor complete las preguntas y programe su cita hoy!
11Questions
  • 1
    Please arrive on time to your appointment. / Por favor llegue a tiempo a su cita.
    Press
    Enter
  • 2
    Press
    Enter
  • 3
    MM/DD/YYYY
    Press
    Enter
  • 4
    Please enter your 10 digit phone number for texting. Mensajes de texto
    Press
    Enter
  • 5
    We will email your results. Le enviaremos los resultados por correo electrónico.
    Press
    Enter
  • 6
    For records only. Solo para registros.
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
    Press
    Enter
  • 7
    Ex: Driver License, Military ID, Passport
    Press
    Enter
  • 8
    Personal Information Privacy and Use of Results: TYDUSGROUP will not receive your individual named sample or results from this test and will not retain any right to test your sample for any purpose other than determining if you test positive for SARS-CoV-2. Under no circumstance will any personal information be made available to, or disclosed by, TYDUS GROUP, with the exception of this Consent Form. Assumption of Risk and Release: I recognize that there are certain inherent risks associated with having my sample analyzed. I hereby consent for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily agree to have my sample analyzed by the Accula SARS-COV-2 PCR Test and hereby waive any and all rights, claims, or causes of action of any kind whatsoever arising out of my participation in this activity, and do hereby release and forever discharge TYDUS GROUP, its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors, and assigns for any physical or psychological injury, including but not limited to illness, paralysis, death, economical or emotional loss, that I may suffer as a direct result of my participation in this activity, including traveling to and from any location related to this activity. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. Indemnification: I agree to indemnify and hold harmless TYDUS GROUP against any and all claims, suits, or actions of any kind whatsoever for liability, damages, compensation, or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If TYDUS GROUP incurs any of these types of expenses, I agree to reimburse TYDUS GROUP for these expenses. Guidance: I understand that the FDA has allowed the use of the Accula SARS-COV-2 PCR Test even though it has not yet been formally approved. According to FDA Guidance, we are required to inform you of the following: (1) This test has not been reviewed by the FDA. (2) Negative results do not rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic should be considered to rule out infection in these individuals. (3) Results from Accula SARS-COV-2 PCR Test should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection or to inform infection status. (4) Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E. (5) This test is not for the screening of donated blood
    Press
    Enter
  • 9

    TEST SCREENING WAIVER / EXENCION DE PANTALLA DE PRUEBA


    This consent provides TYDUS GROUP, and its subsidiaries (“BRIGHTSIDE SPECIALTY PHARMACY”) with your permission to perform an Accula SARS-COV-2 PCR Test based on TYDUS GROUP’s policies and procedures. 

    By signing below, you are indicating that you voluntarily consent to this procedure for the detection of COVID-19.

    The Accula SARS-COV-2 PCR Test being administered involves a nasal swab to obtain a sample which will then be tested for the presence of SARS-COV-2 that may indicate the presence of COVID-19. You will be required to stay in a designated area pending results of the test, and based on the results, you may not be allowed to enter the pharmacy.

    The Accula SARS-COV-2 PCR Test has been allowed for use by the Food and Drug Administration (“FDA”) but has not been approved by the FDA. This test alone may not be sufficient to detect or rule out the possibility that you have been exposed to or are infected with COVID-19. You should carefully monitor your own symptoms and, notwithstanding the results of any testing, you must stay home and consult with your physician if you experience symptoms of COVID-19.

    You have the right to discuss the proposed testing with your physician, to learn about the purpose, potential risks and benefits of any testing.

    By signing below, you consent to the disclosure of such information as requested, recommended or required by federal, state, and local public health authorities.

    Personal Information Privacy and Use of Results. TYDUS GROUP will not receive your individual named sample or results from this test and will not retain any right to test your sample for any purpose other than determining if you tested positive for SARS-CoV-2. Under no circumstance will any personal information be made available to, or disclosed by, TYDUS GROUP, with the exception of this Consent Form.

    By signing below, you agree to release and waive any claim arising from your selection to receive this screening, that may arise against TYDUS GROUP and its designated medical providers and staff members. In addition, by signing below, you acknowledge that any testing that may be performed for Accula SARS-COV-2 PCR has not been approved by the Food and Drug Administration (FDA). Accordingly, you agree to release and waive any claim that might arise against TYDUS GROUP and its designated medical providers and staff members for any risks, side effects, or complications resulting from the testing.
    NEXT
    *    

    Press
    Enter
  • 10
    prevnext( X )
    My Bag
    1
    My Bag
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    ORDER SUMMARY
    Total costUSD
    • COVID-19 PCR RAPID TEST
      COVID-19 PCR RAPID TESTThis test swabs into one of nostrils to the anterior nare - less invasive Esta prueba va a la anterior nare.
      $95.00+Edit
      Back
      Total cost $0.00
      Press
      Enter
    • 11

      Please click one of the PayPal options to complete payment and submit the form.

      Press
      Enter
    • Should be Empty:
    Question Label
    1 of 11See AllGo Back
    close