RAPID COVID-19 Testing

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Please complete this form for the Rapid PCR COVID-19 Nasal Swab Test. (Suitable for travel/airline flights) It is $85 and cannot be processed through insurance. Results will be provided within 15 minutes.
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Signature* This field is required.Please read the following statement in its entirety. Due to high testing demand, we do not allow appointment cancellations. *Tests are $85 and non-refundable* These are rapid RT-PCR Tests. Please verify with your end user if they will accept COVID-19 Tests as clearance, if this is intended for purposes such as: work. travel, nursing home, hospital, etc. By signing your name, you agree to our terms that Oakhurst Pharmacy will not be held responsible for any representations.
Clear
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Appointment Date* This field is required.
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Patient Name* This field is required.
First Name
Middle Name
Last Name
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Gender* This field is required.
Male
Female
N/A
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Date of Birth* This field is required.
Month
Day
Year
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Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
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District of Columbia
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State
Zip Code
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Afghanistan
Albania
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Argentina
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Austria
Azerbaijan
The Bahamas
Bahrain
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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
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Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
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Finland
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French Polynesia
Gabon
The Gambia
Georgia
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Ghana
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Guinea
Guinea-Bissau
Guyana
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
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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
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Northern Mariana
Norway
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Pakistan
Palau
Palestine
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Qatar
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Romania
Russia
Rwanda
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Saint Vincent and the Grenadines
Samoa
San Marino
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Senegal
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South Africa
South Ossetia
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eSwatini
Sweden
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Syria
Taiwan
Tajikistan
Tanzania
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Tonga
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Other
Country
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Cell Phone Number* This field is required.
Please enter a valid phone number.
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Email* This field is required.Required if you would like the results emailed to you
example@example.com
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Race* This field is required.Required by CDC
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Other Race
White
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Ethnicity* This field is required.Required by CDC
Hispanic or Latino
Not Hispanic or Latino
Unknown
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COVID-19 (SARS CoV 2 Assay) via Nasal Swab* This field is required.
Rapid COIVD-19 PCR Nasal Swab Test (Results in 15 mins)
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ICD-10 Code* This field is required.Please stay in your car and pull up to the front of the store if you are symptomatic or have been exposed to someone with COVID. DO NOT COME INSIDE! Please arrive 5 minutes before your appointment and call the store when you have arrived.
Z20.828 - Contact with and suspected exposure to other viral communicable disease (DO NOT COME INSIDE, STAY IN YOUR CAR)
Z11.59 - Asymptomatic, no known exposure, results unknown or negative
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Attention Customers

Our online payments are currently down please read this message in it's entirety.

To secure your appointment slot please call our pharmacy at 732-531-3784 to make a payment over the phone.

Due to high testing demand, we do not allow appointment cancellations.

*Tests are $85 and non-refundable*

We cannot guarantee your appointment without payment ahead of time.
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