On-Site Business Covid-19 Testing

Primary Person

First Name * (optional)

Last Name * (optional)

Phone Number * (optional)

Email * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Street Address * (optional)

City * (optional)

State/Region * (optional)

Zipcode * (optional)

Your Company Information

Street Address * (optional)

City * (optional)

State/Region * (optional)

Zipcode * (optional)

Expected # of tests * (optional)

Company/Organization Name * (optional)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

Add Another Person? * Yes No, thank you.

Additional Person

First Name * (optional)

Last Name * (optional)

Date of Birth *

Test Type * Antibody Test (Results in 10-15 minutes) ($250.00) PCR Non Rapid Test (PNRT) (Results in 5-14 days) ($400.00) PCR Rapid Test (PRT) (Results in 10-15 minutes) ($500.00) Antibody Rapid Test (ART) + PCR Non Rapid test (PNRT) ($600.00) Antibody Rapid Test (ART) + PCR Rapid test (PRT) ($650.00)

I understand that I am scheduling to receive testing for COVID-19. I have been informed that testing is voluntary, that I have the right to decline any tests and that test results will be reported to the state health department as required by law. I understand that as in any medical test, there is a potential for a false positive or negative test result. PCR test results available within 3-5 days. I consent to testing for COVID 19 and agree to these terms. * (optional)