Rapid COVID Test
This test is 100.00 out of pocket. HSA funds may be used to cover the cost or the patient can submit a form for reimbursement to their medical insurance.
street, lot #, apt #
Test results & work/school excuse will be sent via text message unless requested otherwise
*If paying with card, have card ready to present for payment processing.
Example: recent travel (please include location), contact with another lab-confirmed COVID-19 case, clearance for surgery, return to work, etc.)
Pre-existing medical conditions
Consent and Date
I give Surgoinsville Pharmacy consent to perform the test and evaluation most appropriate for myself or child. I consent for the lab to bill my insurance as appropriate.
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