Facility Scheduling Form

Facility Testing Scheduling Form

10 minute Rapid Covid-19 Antigen Test Request

Facility Scheduling Form

First Name(*)

Please let us know your name.

Last Name(*)

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Guardian First Name

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Guardian Last Name

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Patient Date of Birth(*)

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Gender

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Phone(*)

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Your Email(*)

Please let us know your email address.

Primary Physician Name

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Doctor's Phone Number

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Cost of Facility test is $129.00 + $3.95 handling fee.

Total - 132.95 USD

CoviTest Info

After completing this form for the COVID-19 Rapid Antigen Testing. We will contact you within 24 hours to schedule your appointment.

You must submit separate forms for each individual person requesting a test.

YOU WILL HAVE YOUR RESULTS WITHIN 10 MINUTES. IN ADDITION, WE WILL ALSO EMAIL YOU YOUR CONFIDENTIAL REPORT IMMEDIATELY FOLLOWING YOUR VISIT.

10 minute Rapid Covid-19 Antigen Test Request

Facility Scheduling Form

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Helping our community get back to work safely