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Covid-19 Test $150 or free if covered by insurance
Before you can purchase a test you will need to answer a series of questions.
First Name
Last Name
Patient Relationship
Choose an option
I'm registering for myself
I'm registering for someone else
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Birthday
Are you or the person you are filling this form out for exhibiting any of the following life-threating symptos? (check all that apply)
Gasping for air or cannot talk without catching your breath (extremely difficult breathing)
Blue-colored lips or face
Severe or constant pain or pressure in the chest
Severe or constant dizziness or severely lightheaded
Acting confused (new or worsening)
Unconscious or very difficult to wake up
Slurred speech (new or worsening)
New seizure or seizures that won’t stop
None of the above
In the last two weeks have you worked or volunteered in a hospital, emergency room, clinic, medical office, long-term care facility or nursing home, ambulance service, first responder services, or any health care setting?
Yes
No
Continue
Test, Don't Guess
