TEST COVID-19 Testing intake form $50 travel or event

Covid Rapid Antigen $50 - Event or Travel

17788 147th ST SE Monroe, WA 98272 (360) 794-7351
Rapid COVID-19 Antigen Test

Please stay in your vehicle and check in at the drive thru window.

This rapid antigen test is a nasal swab test to see if a person has a current COVID-19 infection. This type of test may be particularly useful if a person has exposure to someone who is suspected to be covid-19 positive. Results from the rapid test will be available same day. Testing is available by appointment only. Testing is available times posted on the booking page. Individuals should remain in the vehicle and a healthcare professional in personal protective equipment will come to your vehicle to collect the sample.

We report results to the local health district. If your test is positive, you may receive a call from public health with further instructions. Please note if you have previously been told to quarantine for 14 days because you are close contact, you will need to continue that entire quarantine period, even if you test results are negative.
Cost for testing is $50.00

Testing for an event or travel.

Testing for travel or event is eligible for insurance reimbursement.
Please complete all information below

By completing this information, you will reserve your COVID-19 antigen test and help to minimize physical contact once you arrive at the test site. Tell us a bit about yourself:
Appointment *
Name *

First Name Last Name
If a minor, Guardian

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
example@example.com
Birth Date *

Month Day Year
Sex at birth
Race *
Ethnicity *
Are you testing for an event or travel? *

No Yes

*

By checking this box, I consent to being tested for COVID-19 by Pharm A Save Monroe, which includes a nasal swab. I understand that Pharm A Save Monroe requires a signed consent and authorization to release confidential information for COVID-19 testing. Positive results will be reported to the Snohomish County Health District. I also understand that, as with any medical test, there is a potential for false positive or false negative test results. Event and Travel testing is not covered by insurance.
Signature *

Clear

Copy of ID
Payment
Due before testing - acknowledge the amount due by typing 50.00

Covid 19 Test - Rapid Results *

USD Covid Test

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

Covid Rapid Antigen $50 - Event or Travel

Please complete all information below