COVID-19 Antigen Test Appointment
Avoid the long lines! Results within 1 hour. The cost is $60, insurance not accepted. You will receive your results via phone and also from the FL Department of Health via text message.
Select your COVID-19 Testing Appointment Time!
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Patient Name
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First name
Middle name
Last name
Date of birth (MM/DD/YYYY)
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/
Month
/
Day
Year
Date
Age
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Address
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Street Address (and unit/apt # if applicable)
Street Address Line 2
City
State / Province
Zip code
State
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Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
You may choose a different option if your State is different
Phone Number
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Sex at birth
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Female
Male
Neither/Other
Unknown
Select the most appropriate status below regarding pregnancy
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Pregnant
Postpartum
Unknown
Neither pregnant nor postpartum
Race (select all that apply)
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Unknown
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other race (specify)
Ethnicity
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Hispanic or Latino
Not Hispanic or Latino
Unknown
Do you have any symptoms?
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Yes
No
Unknown
List your symptoms (if applicable)
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Email Address
*
example@example.com
Payment
*
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Rapid Antigen Test
You will receive your test results on the same day, within 1 hour of test completion.
$
60.00
Credit Card
Signature
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Clear
Date
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Submit
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