The Regency COVID Test Registration

CONWAY'S DANVILLE PHARMACY

RAPID TESTS - COVID/FLU - $55, Strep - $25
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Email Address*
example@example.com
Phone Number*
Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
WE DO NOT BILL INSURANCE. CHECK, CASH OR CREDIT CARD - $25-$55
Covid/Flu - $55Strep - $25
Appointment
Should be Empty: