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Grand Care Pharmacy COVID-19 Form
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  • 1
    Testing Starts At 10AM Daily!
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  • 2
    Please call the pharmacy for any last minute openings. Thank You
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  • 3
    For multiple family members, please only select one appointment! (Only 1 appointment needed per family/group)
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  • 4
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  • 5
    Testing Starts At 10AM Daily! You must have an appointment TIME slot booked on previous screen unless otherwise authorized by pharmacy personnel.
    Pick a Date
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  • 6
    For your reference
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  • 7
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  • 9
    MM-DD-YYYY
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  • 10
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  • 12
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  • 13
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  • 14
    Required By CDC
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  • 15
    Required By CDC
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  • 16
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  • 17
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  • 18
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  • 19
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  • 20
    Name of Insurance Company
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  • 21
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  • 22
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  • 23
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  • 24
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  • 25
    Needed if you need the results emailed to you
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  • 26
    Drivers License, Passport, Etc
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    Max. file size: 10.6MB
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  • 27
    Drag and drop files here
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    Max. file size: 10.6MB
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  • 28
    Payment is nonrefundable; We will provide an itemized receipt if you would like to submit this to your insurance for possible reimbursement.
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      ORDER SUMMARY
      Total costUSD
      • Rapid COVID-19 TESTFastest way to get in and out is by paying online
        $120.00+
        Back

        Rapid Antigen Test
        • Rapid Antigen Test
        • Rapid PCR Test
        • Pay In Person
        Subtotal: $0.00
        Total cost $0.00
        Credit Card (If paying IN person, simply click submit) Paying Online is the fastest method!
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      • 29
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      • 30
        • BD VERITOR Analyzer System
        • ACCESS BIO CareStart System
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      • 31
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