rapid test online Form

PCR TEST:

This is not a rapid test. Currently, the results are expected to be ready the next day afternoon (not guaranteed). The pharmacy is a collection site for tests, specimens gets shipped to the lab via FedEx priority overnight service. Please do not call the pharmacy to inquire about test results. If the test result is inconclusive or invalid, the test will need to be repeated. Please present your insurance card and valid ID at your appointment. We do not recomment this test for travel purpose as it is possible that Fedex doesn't deliver the shipment on time.

RAPID ANTIGEN TEST: (COVID-19)

The cost for the rapid antigen test is $69. You will be provided an invoice to submit to your insurance for reimbursement. Rapid test currently can take up to 1 hour. Please pull up to our drive-thru window at your appointment time, to perform the test. Results can be either emailed or texted to you. Please bring a valid government ID to your appointment.

RAPID ANTIGEN TEST: (COVID-19 and Flu)

The cost for the rapid antigen test is $99. You will be provided an invoice to submit to your insurance for reimbursement. Rapid test currently can take up to 1 hour. Please pull up to our drive-thru window at your appointment time, to perform the test. Results can be either emailed or texted to you. Please bring a valid government ID to your appointment.

RAPID PCR TEST:

The cost for the rapid RT-PCR test is $120. This test is normally required for international travel. Rapid PCR test can take up to 2 hours. QR code is available upon request. Most insurances do not cover this test for travel purposes and only covers it for medical necessity. We do not submit claims to insurances for this test. The test is performed at the drive-thru window. Results can be texted, emailed or both. This is the test we recommend for travel purpose.

NOTE:

The pharmacy does not handle inquires about the non-rapid PCR test, over the phone. Any inquiry can be e-maild to Pharmacist@caringwellnesspharmacy.com

Location: 1097 Loudon Rd. Cohoes NY 12047

What type of test you are requesting?*

PCR (molecular non-rapid )Rapid COVID-19 (Antigen rapid)Rapid PCR (molecular rapid)Rapid COVID-19 and Flu (Antigen rapid)

Name*

First Name Last Name

Date of Birth*

Date

Gender*

MaleFemaleOther or prefer not to answer

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Cell Phone Number*

Please enter a valid phone number.

Primary Care Doctor

Email

example@example.com

Do you have any COVID 19 symptoms*

YesNo

What are your symptoms*

Date of onset of symptoms*

Date

Did you have known contact with another COVID-19 positive case?*

YesNo

Are you a healthcare worker or someone who interacts directly with the public*

YesNo

Have you travelled 14 days prior to testing*

YesNo

Location*

Depart/Return Date*

Date

Are you fully vaccinated (2 weeks since last dose)?*

YesNo

What vaccine did you receive?

pfizermodernaJ&JOther

Appointment for PCR test*

Appointment for RAPID ANTIGEN test*

I give permission to Caring Wellness Pharmacy to perform my COVID 19 testing and report my results to NY state as required by law.

**PLEASE NOTE**

Our Pharmacists have the abitily to prescribe Paxlovid for patients who test positive and have mild to moderate symptoms. Please contact the pharmacy for assessment of symptoms. Paxlovid prescriptions have $0 copay.

Signature*

Clear

Appointment for PCR or Rapid Antigen/PCR* COVID 19 test