Ready Test Go!

Patient Information

Please provide your full name, birth date and gender.

First Name

Last Name

Birth Date

Mobile Number

verify

Email Address

Male

Female

Next >

NEXT Button will appear when this step is complete.

Start Over

Are you a U.S. Resident?

YES

Next >

NEXT Button will appear when this step is complete.

Start Over

Patient Address

Please provide your street address.

Country

Street Address

ZIP Code

City

State

Province/District

Next >

NEXT Button will appear when this step is complete.

Start Over

Vehicle Information

Make
Model
Color

Next >

Start Over

Purpose of Testing Today

I have symptoms of COVID-19 or have been directly exposed to COVID-19

No Cost if Insured

I am screening for travel, work, school or entertainment purposes and have no symptoms of COVID-19

Fees Apply

Health Questionnaire

Do you have any of the following Symptoms?

Contact with COVID-19?

Sore Throat

Fever

Cough

Shortness of Breath

Loss of Smell

Loss of Taste

Headache

Diarrhea

Muscle or Body Aches

Next >

Start Over

Risk Factors

Do you have any of these conditions?

Diabetes

Hypertension

Cardiovascular Disease

Respiratory Issues

Autoimmune Disorder

Next >

Start Over

Choose Service

Covid19 Flu A B Bundle

SARS CoV2, Influenza A and B, Bundled via PCR

Covid19 Np Pcr 2022

SARS COV2 PCR MOLECULAR NP SWAB VIA ATILA POWERGENE 9600 PLUS

Start Over

Agreement

I Agree

Start Over

Do You Have Insurance?

YES

Insurance Name

Policy ID

Group

Subscriber First Name

Subscriber Last Name

Relationship

Self

Spouse

Child

Other

Next >

NEXT Button will appear when this step is complete.

Start Over

HRSA Unavailable

By providing my information I, , attest that I do not have coverage through an Individual, Employer or Federal health plan as of today, December 5, 2023.

I am Providing

Driver License

Social Security Number

Green Card

Other

Type of ID

Issuing State

Social Security Number

Identification Number

Next >

NEXT Button will appear when this step is complete.

Start Over

Credit Card Payment ($ 142.63)

Card Number

CVV

Expiry

Cardholder Name

Country

Street Address

ZIP Code

City

State / Province

Pay Now

PAY Button will unlock when complete.

Please Click Only Once
to avoid multiple charges

Start Over

PAY $ 99

APPROVED!

Please ask clerk for your test kit and enter your code below.

Enter Specimen Code

Re-Type Specimen Code

FINISH

Please Take a Photo of Your Insurance Card

CAMERA

FILE

Patient Information

Are you a U.S. Resident?

Patient Address

Vehicle Information

Purpose of Testing Today

Health Questionnaire

Risk Factors

Choose Service

Agreement

Do You Have Insurance?

HRSA Unavailable

I am Providing

Credit Card Payment ($ 142.63)

Please Click Only Onceto avoid multiple charges

APPROVED!

Please Take a Photo of Your Insurance Card

Please Click Only Once
to avoid multiple charges