Web: Drive Covid Form

Instructions

Thank you for choosing Trident Labs, Inc. to perform your testing! Please fill out the form below and proceed to the nearest HealthBar drive-thru location within 72 hours to complete the testing. Please have your email confirmation ready upon arrival.
Personal Information
First Name *
Last Name *
Date of Birth *

Month Day Year
Date of Birth
Current Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *
Please enter a valid phone number.
Gender *

Female Male
Ethnicity
Race

Consent for Testing

By typing your name below, you are signing a Trident Labs document. You agree that you have full authority to act on behalf of the person entering this agreement, acknowledge that you accept all of the terms in this agreement and that your electronic signature is the legal equivalent of your manual signature for this document.
Type Full Name *

Ticket Number (RANDOM)
You're so close!

Once you press submit you will receive an email with your invoice. You will need to present the bottom QR code at the HealthBar drive through and they will collect your specimen and you will receive results in 24 hours to the email you provide below. Be sure it is correct!
Reporting Email *
How did you hear about Trident's Covid testing?

I heard it from a friend I saw it advertised online I searched online for testing My employer told me about it Other
Verification

My Products *

COVID-19 PCR Test Ticket Covid-19 PCR Test & Collection via Anterior Nares.

$ 85.00

Enter coupon

Total

$ 0.00

Instructions