COVID TESTING PAYMENT

CONTACT FULL NAME: *
CONTACT E-MAIL: *
SELECT A TEST: *

SELECT A TEST: COVID-19 ANTIBODY COVID-19 ANTIGEN COVID-19 PCR COVID-19 RAPID ANTIBODY COVID-19 RAPID ANTIGEN COVID-19 RAPID PCR
IS THIS A MOBILE COLLECTION? *

IS THIS A MOBILE COLLECTION? YES NO
# OF ANTIBODY TESTS:

# OF ANTIBODY TESTS: 1 2 3 4 5
# OF ANTIGEN TESTS:

# OF ANTIGEN TESTS: 1 2 3 4 5
# OF COVID PCR TESTS:

# OF COVID PCR TESTS: 1 2 3 4 5
# OF RAPID ANTIBODY TESTS:

# OF RAPID ANTIBODY TESTS: 1 2 3 4 5
# OF MOBILE RAPID ANTIGEN TESTS:

# OF MOBILE RAPID ANTIGEN TESTS: 1 2 3 4 5
# OF RAPID ANTIGEN TESTS:

# OF RAPID ANTIGEN TESTS: 1 2 2 4 5
# OF RAPID PCR TESTS:

# OF RAPID PCR TESTS: 1 2 3 4 5
# OF MOBILE RAPID PCR TESTS:

# OF MOBILE RAPID PCR TESTS: 1 2 3 4 5
SELECT A SITE LOCATION: *
REQUEST A DATE OF PREFERRED SERVICE: REQUEST A DATE OF PREFERRED SERVICE: / MM / DD YYYY
NOTE: Allow 1-week notice for new clients. This time will allow us to setup an informational session with you to discuss details and additional questions you may have.
PREFERRED TIME-SLOT: *
$0

Total