In the past 14 days have you experienced any of the following symptoms? Fever >100, cough, fatigue, shortness of breath, change in taste or smell, nasal congestion, nausea or vomiting?
Have you been in close contact with someone who has tested positive for COVID-19 in the last 14 days?
In the last 14 days, have you traveled to a state considered to be high risk for COVID-19 infection?
Are you currently a smoker?
Have you ever been a smoker?
Have you received your 2023-2024 flu vaccine?
Is this appointment for COVID testing related to Travel, Return to Work, or Return to school? If Yes, we will be unable to process the visit through your health insurance and will instead collect $150 at the time of service for your visit.
I understand that if I am registering for an Immigration Physical ONLY I will be contacted by a member of the team to discuss pricing and to collect a non-refundable $200 deposit for the visit
I acknowledge that if my reason for COVID19 testing is for travel, work, school or social gathering we are unable to process your visit through insurance and will be charged $150
I acknowledge that if I decline an office visit with a licensed provider inside the clinic, I will be tested at the car-side with a molecular COVID19 test (PCR or Rapid) at a cost of $150
READ BEFORE CONTINUING: If you are symptomatic or exposed, booked an appointment for Queue #1, and would like to process your Rapid COVID19 test through insurance you must have an exam by a licensed provider. This exam means your visit be longer than just the time it takes to perform a nasal swab. There may be delays in your appointment time if there are emergencies or other urgent patients in the clinic. We appreciate your patience and understanding. If you prefer to experience a quicker visit with no examination, please select option #2 to pay for a COVID19 test ONLY, not processed through insurance.
Would you like to receive your flu vaccine during your visit with us?
