Please complete the following information in advance if your appointment.
Book an Appointment for
COVID-19 Rapid Antigen Test ($115)
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Date of Birth
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What is your Race?
Have you been in contact with someone who has been exposed to COVID-19 or has a confirmed case of COVID-19?
In the last 48 hours, have you had any of the following symptoms?
fever of 100f (37.7 C) or above/ possible fever symptoms like alternative chills and sweating
Trouble breathing/shortness of breath or severe wheezing
Loss of taste
New Choice (3)
None of the Above
Have you or anyone in your household traveled outside of the State of New Jersey in the past 14 days?
Do we have permission to text you or leave a message on your phone?
Is there anything else we should know about your reason for coming in for a COVID-19 test?
How did you hear about us?
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Currently a patient in the office
Due to high demand of tests, we do not allow cancellations. Once payment is made, the Rapid test is non-refundable. By clicking yes, you agree to these terms.
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