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Please fill out this form. Note at this time Vashon Pharmacy cannot bill medical insurance for these services. Payment will be collected at the end of this signup and no reimbursement will be made from Vashon Pharmacy. We are working hard to be able to bill medical insurance and are hopeful that by end of year 2022 we will have that capability. 
22Questions
Covid Testing Form
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    This form is to sign up for a fee for service program offered by Vashon Pharmacy. These services are meant to close gaps in care on Vashon Island. Unfortunately, as a pharmacy we are not yet able to bill medical insurance for these services. We are continuing to work towards billing insurance and are hopeful it will be possible at some point in 2022. 

    The cost of these services is outlined on the following slide and a secure payment portal using Square will collect payment prior to submission if necessary. Click next at the bottom of the page to proceed and provide the necessary information needed. 

     

    Click next/arrow below to proceed

     

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    Types of tests offered by Vashon Pharmacy and the associated out-of-pocket cost of each. 

     

    Rapid-Antigen - COVID 19 - Free (paid for by DOH while supplies last) 

    Rapid-PCR - COVID  19 (Travel/Medical/Event) - $125 

    Rapid Strep - $45

     

     

    Click next/arrow below to proceed

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    Who can administer their tests...

     

    Children 5 and under will have their test administered by a practitioner at the test site. 

    Children age 6-18 will need to have their swab observed by an adult or practitioner. 

    Adults age 18 and up may administer their own swab if comfortable and be asked to return the sample to the mobile unit.

    Click next/arrow below to proceed

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    EX: nursing home, group home, prison, jail or military
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    If you have no symptoms please say N/A or leave blank
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  • 19
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    Pick a Date
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  • 20
    Please select your desired testing solution below. Patient is responsible for verifying that any test is acceptable for their testing needs in regards to employment, travel, etc. The state did not renew our PCR test discount and as such our cost to acquire the cartridges increased substantially. The new price is reflected below.
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      ORDER SUMMARY
      Total costUSD
      • Rapid Antigen Point of Care Test
        Rapid Antigen Point of Care TestThis test is administered or overseen by a provider, this test is similar to AT-Home tests except patients will get a validated result. This is most accurate when a patient has COVID-19 Symptoms
        $Free+RemoveEdit
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      • Rapid PCR Point of Care Test
        Rapid PCR Point of Care TestThis is a rapid PCR (gold standard for testing) that can be used as a valid test for travel on airlines, through borders (where accepted) and for pre-surgery or event screening. A valid test result will be supplied within 12 hours of test. This test does not work for Hawaii travel.
        $125.00+RemoveEdit
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      • Rapid Strep Test
        Rapid Strep TestThis test is used to detect the presence of Group A strep, this is a throat swab test using the BD Veritor System
        $45.00+RemoveEdit
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        Total cost $0.00
        Credit Card - If you do not owe for your selected test (Total Cost reads $0.00) you may click next. Credit card information is only required if payment is required.  
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        Test will take place outside the pharmacy. Please check in at the pharmacy trailer
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      • 23
        By signing below I understand that my credit card supplied will be charged in advance for anticipated services. I understand that should I miss or cancel the appointment with less than 24 hours notice that a $15.00 fee will be charged while any cost in excess of that will be reversed for services not ultimately provided. Additionally I understand that my information may be shared with other health care providers in the interest of my personal health care and that of the community. This communication may include but not be limited to contact tracing, therapy discussion quarantine and isolation advice. Vashon Pharmacy works closely with VashonBePrepared and the Medical Reserve Corp on Vashon. Vashon Pharmacy is obligated by law to report all test results to the local health department. I acknowledge that the contact information I provided is accurate and that if information was entered incorrectly I may not receive the needed communication. I attest that I do not hold Vashon Pharmacy or any of its test administrators liable for any harm during the collection of this sample and I completely hold them harmless of any injury of any kind. If for any reason this test cannot be performed by Vashon Pharmacy due to unexpected staff shortages or acts of god and no reasonable accommodation can be made that I will receive a full refund.
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