Rapid Covid PCR Test Registration
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
Date of Birth
I certify I or my dependent is not enrolled in Medicare/Medicaid. I waive my insurance coverage and understand this is a non-covered benefit. I am asymptomatic and am requesting this test for travel, holiday or personal reasons and will not file a claim for these services. I am choosing freely to pay for this service.
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RAPID PCR COVID TEST
Real Time Rapid PCR NAAT 1 HOUR Test No show will be charged a 25.00 service fee.
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