Med2u Inc. Hollywood FL Location

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Hollywood, Florida Clinic

Covid-19 Testing at 510 North Dixie Hwy. Hollywood, FL 33020
Number Of Patients*

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Lead Patient Name *

First NameLast Name
Phone Number
E-mail*
example@example.com
Date Of Birth*

MonthDayYear
Gender*
If You Are Testing Due To Upcoming Travel Plans, Please Enter Departure Date.

MonthDayYear
Date
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 2
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 3
Name*

First NameLast Name
Date Of Birth*

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 4
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 5
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 6
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 7
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 8
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 9
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 10
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 11
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 12
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 13
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:*
Patient 14
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 15
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 16
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 17
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 18
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 19
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 20
Name*

First NameLast Name
Date Of Birth *

MonthDayYear
Date
Gender*
Please enter your passport number below if you'd like for us to include It On Your Report:

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Covid-19 PCR tests have a cut-off time of 7PM EST for next business day results.
Appointment Date And Time*
A Med2u Inc. Representative will reach out to confirm your appointment time.

My Products*

COVID-19 RT PCR Test $ 200.00$200.00

Receive the lab report results in the evening of the following business day.

Quantity

Covid-19 Antigen Rapid Test $ 150.00$150.00

Receive results in 15-30 minutes

Quantity

Rapid Antibody IgG & IgM Test $ 100.00$100.00

Receive results in 20 minutes

Quantity

Total $0.00

Credit Card

Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Notes and Special Instructions
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Should be Empty:

Hollywood, Florida Clinic

Patient 2

Patient 3

Patient 4

Patient 5

Patient 6

Patient 7

Patient 8

Patient 9

Patient 10

Patient 11

Patient 12

Patient 13

Patient 14

Patient 15

Patient 16

Patient 17

Patient 18

Patient 19

Patient 20

Covid-19 PCR tests have a cut-off time of 7PM EST for next business day results.

Credit Card