Rapid COVID-19 Testing
Cope and Fedullo Medical Services PLLC
First Name*
Last Name*
Date of Birth*
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Race (Check all that apply)*
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Phone Number:*
E-mail*

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Employed (EMP) or Student (STU) (If Neither skip to next question)
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Name of Employer or School
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Street Address
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Please enter a valid phone number.
Do you currently have any symptoms of COVID-19 such as fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting or diarrhea?
Yes No Unsure
Have you had close exposure to someone with COVID-19 in the last 10 days?
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Have you tested positive for COVID-19 in the last 10 days?
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Rapid COVID-19 TestingPlease enter a short description.
$60.00

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Your test report will take approximately 25 minutes to prepare. You can return at that time for a written report or we can text you the result (we call you if it is positive) and email you a written report.*
Will return in 25 mins for written report Please text me result (or call if positive) and email me the report
To text you the result which cell phone carrier do you use?*
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Rapid COVID-19 Testing

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