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  • Pharmacy Testing Form

    500 4th Ave, Brooklyn, NY 11215
    • Section - Form Body 
    • Testing Options

      Select the testing you would like to receive. Rapid test results are within 15 minutes. PCR test results are within 24-48 hours.
    • Patient Information

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    • Patient Questions

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    • Upload File
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    • Upload File
      Drag and drop files here
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    • Section - Form Consent 
    • Consent

      • I acknowledge that all information I entered in this form is accurate and true.
      • I authorize this facility to collect a sample specimen for me in order to perform this test.
      • I release the facility and all of its employees and affiliates, from any liabilities, damage, or accidents related to this testing activity.
      • I authorize this facility to share with the requester (e.g., company) my health care information, including diagnostic test results and medical test results.
      • I understand that this diagnostic test is for informational purposes only. This facility will not admit patients or provide medical advice.
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