New York Concierge Covid-19 Testing
Schedule a Technician to come collect your sample from the comfort of your Home or Office
Number Of Patients
*
1
2
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5
6
7
8
9
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Lead Patient Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Address Of Test Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Of Birth
*
-
Month
-
Day
Year
Gender
*
Female
Male
If You Are Testing Due To Upcoming Travel Plans, Please Enter Departure Date.
-
Month
-
Day
Year
Date
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 2
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 3
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 4
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 5
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 6
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 7
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 8
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 9
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 10
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 11
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 12
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 13
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
*
Patient 14
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 15
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 16
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 17
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 18
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 19
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Please enter your passport number below if you'd like for us to include It On Your Report:
Patient 20
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Please enter your passport number below if you'd like for us to include It On Your Report:
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Covid PCR tests have a cut-off time of 6:30PM EST for next business day results.
Select Your Appointment Date
*
-
Month
-
Day
Year
Date
Select Your Preferred Time Frame
*
9AM - 12PM
12PM - 3PM
3PM - 7PM
A Med2u Inc. Representative will reach out to confirm your appointment time.
My Products
*
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COVID-19 RT PCR Test $ 200.00
$
200.00
Receive the lab report results in the evening of the following business day.
Quantity
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Covid-19 Antigen Rapid Test $ 150.00
$
150.00
Receive results in 15-30 minutes
Quantity
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Rapid Antibody IgG & IgM Test $ 100.00
$
100.00
Receive results in 20 minutes
Quantity
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Subtotal
$
0.00
Shipping
$
0.00
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Notes and Special Instructions
Submit
Should be Empty: