- Agree to Terms & Conditions. By continuing, you agree: You are 18 years old or older or 2) the parent or legal guardian of a minor patient 3 years old or older or 3) the legal guardian of the patient in Nebraska - Parent or legal guardian consent is required for testing individuals under the age of 19** in Puerto Rico - Parent or legal guardian consent is required for testing individuals under the age of 21** You're not experiencing severe symptoms such as severe shortness of breath, continuous pain or pressure in the chest, or persistent fever greater than 102ºF. If you're experiencing severe symptoms, please seek medical attention immediately. You acknowledge that your or the minor patient’s information will be used as described in the iPharma Pharmacy Notice of Privacy Practices Opens in a new tab. You acknowledge that your information will be used as described in iPharma Pharmacy Notice of Privacy Practices You agree to receive email communications that contain information about your or the minor patient’s eligibility for COVID-19 testing and COVID-19 testing appointments. By selecting "I agree" below, you also have read and accept iPharma Pharmacy Terms of Use Opens in a new tab*
- Patient date of birth*
Format: (000) 000-0000.
- COVID-19 Test Questionnaire Please answer all questions to the best of your ability to determine your eligibility for COVID-19 testing.1. Do you currently have any of the following symptoms? (Select all that apply)*
- In the last 14 days, have you had contact (been within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period, starting from 2 days before illness onset until the time the infected person is isolated) with someone who's been diagnosed with (or is presumed to have) COVID-19?*
- In the last 2 weeks, have you been in contact (within 6 ft. of the person for a prolonged period of time or been coughed on) with someone who is sick but has not been diagnosed with COVID-19?*
- In the last 2 weeks, have you had any of the following exposures? (Select all that apply)*
- Do any of the following describe your work setting? (Select all that apply)*
- Do you have any of the following conditions? (Select all that apply)*
- Are you currently pregnant?*
- Have you received the COVID-19 vaccine?*
- Date of vaccination, first dose
- Date of vaccination, second dose
- Available Tests, please select one
- Appointment Date
- Time
- Insurance
- Should be Empty: