COVID Test Plumsted Pharmacy

Plumsted Pharmacy RAPID COVID Test

This is a healthcare provider administered Point of Care Test that tests for SARS COVID-19, Flu A and Flu B. There is a $100 charge for rapid tests. At this moment we are asking that ALL patients do not enter the store. Please contact the pharmacy at the number below when you are parked outside. If you have any questions/concerns please call 609-758-8829. If you are unable to find an appointment time that works for you please call the number above to see if we have emergency appointments available.
Name*

First NameLast Name
Date Of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Patient Gender *
Race*
Ethnicity*
Email *

Confirmation EmailThis must be unique for each patient requesting a vaccine to get confirmation e-mails.
COVID-19 Testing Questionnaire
Type of Test Requested *
Reason for test

Symptoms (Fever, Chills, Cough, etc)Contact/ExposureTravelRe-test/Return to work or school
Available Appointment Times
Available Appointment Times (WEEKEND APPOINTMENT)

My Products*

Rapid COVID-19 Test plus Flu A and Flu BRapid Covid-19 & Flu A and Flu B Test : Results in 15 minutes

$100.00

Rapid Strep TestTests for Group A strep: Throat Swab; Results in 15 minutes

$45.00

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Total

$0.00

Insurance / Coverage Information
Card Information for Private/Commercial Insurance (located on front or back of card)

Health Insurance Name
Health Insurance ID #
If Un-insured: I attest that I do not have any insurance.
I certify that I am the Patient or guardian of a patient receiving a EUA COVID-19 test. I give my consent to the health care provider Plumsted Apothecary Inc, as applicable to administer the test(s) I have requested above. I understand that it is not possible to predict all possible side effects or complications associated with receiving these tests and all test results must be used as a component along with the advice and guidance of your healthcare provider. Positive test results should be brought to the attention of your medical doctor and used with their professional judgement as a course of treatment. Negative results do not mean that you should not follow up with your medical doctor if your condition does not improve or worsens. I acknowledge that I have had a chance to ask questions and that such questions were answered to my satisfaction. On behalf of myself,my heirs, and personal representatives, I hereby release and hold harmless Plumsted Apothecary Inc, as applicable, its staff, agents, successors, divisions,affiliates, subsidiaries, officers, directors, contractors, and employees from any and all liabilities or claims whether known arising out of, in connection with, or in any way related to the administration of the test(s) listed above.I authorize Plumsted Apothecary Inc, as applicable to release any medical or other information to my health care professionals, as necessary with respect to the test(s) listed above.*

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Payment must be made via credit card. Due to high demand appointments are non refundable and no cancellations are allowed. *

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Plumsted Pharmacy RAPID COVID Test

COVID-19 Testing Questionnaire

Insurance / Coverage Information