SHP Linden NJ Form

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Select type of COVID-19 Test at Super Health Pharmacy Linden NJ * This field is required.Testing Starts At 10AM Daily!

Covid PCR Test Nasal Swab (Results within 2-3 business days) FREE* (No appointment required)

Rapid Covid Test Nasal Swab (Results within 15 minutes) $115 (No appointment required) Super Health Pharmacy Linden NJ

Rapid COVID-19 PCR Nasal Swab Test $175 (Results within in 15 minutes) (No appointment required) Recommended for Travel, Medical Procedures, etc

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Appointment For COVID PCR Test (Result by 2-3 business days)For multiple family members, please only select one appointment! (Only 1 appointment needed per family/group)

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Pharmacy Phone For your reference

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Patient Name* This field is required.

First Name

Last Name

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Middle Initial

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Date of Birth* This field is required.MM-DD-YYYY

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Patient Address * This field is required.

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City* This field is required.

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State* This field is required.

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ZIP Code* This field is required.

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Race** This field is required.Required By CDC

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Ethnicity** This field is required.Required By CDC

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Cell Phone* This field is required.

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Gender* This field is required.

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COVID 19 (SARS CoV 2 Assay) via Nasal Swab* This field is required.

COVID 19 (SARS CoV 2 Assay) via Nasal Swab

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ICD-10 Code* This field is required.

Z20.828 Contact with and suspected exposure to other viral communicable disease

Z11.59 Asymptomatic, no known exposure, results unknown or negative

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Email *

example@example.com

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Picture of Government Issued IDDrivers License, Passport, Etc

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Select files to upload

Max. file size: 10.6MB

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Picture of Insurance Card

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Max. file size: 10.6MB

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