Drive-Thru Testing Appointment Form
Date of Birth
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
Total Number of People for Swab Testing
Additional Person Information
Select Appointment Time
Select Payment Option
Cash (On-Site Payment)
Credit Card (On-Site Payment)
Total Amount ($120.00 per person)
On the day of your appointment, please be ready 15 minutes early.
Please bring your valid government-issued ID.
Our professional medical staff will perform the swab test.
We will send your test results via e-mail.
Should be Empty: