COVID-19 Testing Invoice Request
If you received your COVID-19 Test through Skippack Pharmacy's lab and are requesting an invoice/results sheet, we would be happy to provide you an updated sheet that can be emailed to you. Please provide the information herein and allow up to 3 business days for processing. The form we provide is for your information; as signed for at the time of booking the appointment, we cannot make any guarantees that the information we provide will get you reimbursement from your insurance company. Thank you!
Name of Patient
*
First Name
Middle Name
Last Name
Date of Birth of Patient
*
-
Month
-
Day
Year
Date of Test
*
-
Month
-
Day
Year
Email Address You Registered With
*
Confirmation Email
Confirm your email address in both spots above.
Which Test You Had Received?
*
Rapid Antigen Test
Rapid PCR Test
What was the Result of your Test?
*
Positive
Negative
Is there anything additional we should know?
Preview PDF
Submit
Should be Empty: