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August 15, 2022

No Appointment for selected date

Step 1


Do you have insurance? *

If you do not have insurance be sure to read the information below

Agreement / Signature
Patient certification: By reading this information, the medical professional acknowledges that the individual/family member authorized to make decisions for the individual (collectively, the “Patient”) has received information regarding the process and consented to undergo selected testing. No test other than the specific test ordered shall be performed on the biological sample.

By eSigning this consent you agree if it is found you have insurance you will be financially responsible for all costs related to this test (approximately one hundred thirty five dollars approx.).

Step 2

Personal Details

Set Password
  •   Your password must contain at least one lowercase.
  •   Your password must contain at least one uppercase letter.
  •   Your password must contain at least one number (0-9).
  •   Your password must contain at least one special character.
  •   Space between characters is not allowed.
  •   Your password must be between 6 and 30 characters.
  •   Passwords do not match.
Patient Ethnicity
I consider myself: *
Patient Race
Which of the following racial designations best describes you (select one or more): *

Step 3 Title

Insurance / Payment Details

Do you have insurance? *
How will you be paying? *

Step 2

Insurance Details

Upload Insurance Front Side*
Upload Insurance Back Side*

Upload Driving License Front Side
Upload Driving License Back Side

Step 4 Title


I have the following condition(s): *
I have a condition that weakens my immune system or makes it harder to fight infections: *
I am taking one of these medications: *
I am or may be pregnant
I regularly use tobacco or nicotine products (e.g. cigarettes, e-cigarettes, vapes, hookah, etc.)
Have you possibly been exposed to the Coronavirus in the past 2 weeks? *
I have been in close proximity (within 6 ft.) to someone who has been diagnosed with or presumed to have COVID-19. *
I have been in close proximity (within 6 ft.) to someone who is sick but has not been diagnosed with COVID-19. *
I live, work or have visited a place where COVID-19 is widespread. *

Step 5 Title


Have you had any of the following symptoms: *
Are you currently experiencing any of these symptoms? *
How did you hear about us?

Step 6 Title

What type of test would you like to have?