COVID-19 PCR Testing Form Carman Drugs

COVID-19 PCR Testing Form
Following your appointment, you will be notified via email or text message of your results within 24-72 hours.

Please bring a photo ID and your medical insurance card.

There is no charge for PCR testing if you have insurance.

If you do not have insurance, the charge for the PCR test is $50.

The address is 829B Carman Ave, Westbury, NY 11590.
Name *

First Name Last Name
Date of Birth *

Month Day Year
Gender at Birth *
Home Address *

Street Address

Street Address Line 2

City State Initials

Zip Code Country
Cell Phone Number *
Email Address *
Race *
Ethnicity *
Employment *
COVID-19 PCR Testing Appointment *
Note: If you do not receive a confirmation email, you do not have an appointment.
Should be Empty: