Non-Corporate Testing*

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Please Select a Testing Location: * This field is required.
Olmos Park (4401 McCullough Ave 78212 - Frog Car Wash)
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Please select a Date and Time For Olmos Park* This field is required.
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PHTX- Unique ID
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E-mail* This field is required.
example@example.com
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Full Name* This field is required.
First Name
Last Name
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Date of Birth* This field is required.(Tap year to get started)
Date
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Day
Year
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Age* This field is required.
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Gender* This field is required.Male= M Female= F Other= O
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F
O
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American Indian or Alaska Native
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Unknown
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Ethnicity* This field is required.
Hispanic
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Phone Number Area Code and Phone Number
XXX-XXX-XXXX
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Address* This field is required.
Street Address
Street Address Line 2
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County of Residence* This field is required.
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Need to add another member from your household to this appointment?(If you have more than 5, please let us know)
First Name
Last Name
Date of Birth (mm/dd/year)
Age
Gender
Additional 1
Additional 2
Additional 3
Additional 4
Additional 5
Additional 1
Additional 2
Additional 3
Additional 4
Additional 5
First Name
Last Name
Date of Birth (mm/dd/year)
Age
Gender
First Name
Last Name
Date of Birth (mm/dd/year)
Age
Gender
First Name
Last Name
Date of Birth (mm/dd/year)
Age
Gender
First Name
Last Name
Date of Birth (mm/dd/year)
Age
Gender
First Name
Last Name
Date of Birth (mm/dd/year)
Age
Gender
1 of 5
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My Products* This field is required.
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My Bag
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My Bag
Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costUSD
Rapid 15-minute Antigen Covid-19 testRapid COVID19 Antigen test (best to use with symptoms after an exposure)
$120.00+Edit
Back
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Quantity
Subtotal: $0.00
1hr All in One Covid-19/Flu/RSV PCR test PCR COVID test (best to use with or without symptoms or for certain travel requirements)
$180.00+Edit
Back
Quantity
Subtotal: $0.00
1hr All in One Covid/Flu/RSV PCR and Antigen ComboIncludes: Rapid 15 minute antigen test and 1 hour A PCR test
$295.00+Edit
Back
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Quantity
Subtotal: $0.00
Enter Coupon
Total cost $0.00
Credit Card
First Name
Last Name
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Select all that apply* This field is required.
I have been tested for COVID-19 before
This is my first COVID test
I am employed in health care
I am symptomatic
I have been hospitalized
I have been placed in the ICU
I am a resident in a communal (assisted living) care setting
I am pregnant
None of these apply to me
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Please provide us information on your previous COVID test.* This field is required.This field is state mandated.
When was the date of your test? Type in the form of : MM/DD/YYYY
What was the result? Answer Positive or Negative.
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When was the onset of your symptoms?This field is state mandated.
Please answer in MM/DD/YYYY format
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Signature* This field is required.I authorize Premier Tests, LLC DBA Premier Health TX to send emails, text, and phone correspondence for any lab results following HIPPA regulations. Health information, including labs results, will only be shared with individuals and their guardians. If you authorize another to discuss your medical information please email us at info@premierhealthtx.com.
Clear
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Result
PositiveNegative
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Email Sent
YesNo
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