• COVID-19 Rapid Antigen Test

    Insurance Currently Not Accepted

    Cost of Test: $60

  • Patient Information

  •  -  -
    Pick a Date
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Clinical Information

  •  -  -
    Pick a Date
  • Test Information (For Pharmacy Use Only)

  • Please Read Statements Below

  • Signature

  • Clear
  • Terms & Conditions

    The United States FDA has made this test available under an emergency access mechanism called an Emergency Use Authorization for the detection of SARS-CoV-2.• A negative result must be interpreted along with clinical observations, patient history and epidemiological information. • A negative result means that SARS-CoV-2 was not present in the specimen above the limit of • A positive result for COVID-19 indicates that SARS-CoV-2 was detected and the patient is presumptively infected with virus and presumed to be contagious. • Check with your end user to make sure they accept a Rapid Test. Rios Pharmacy is not responsible for any representations. I agree payment will be collected either before or after testing is completed.
  • Rios Pharmacy

    35 South Morton Ave, Morton, PA 19070

    Phone: (610) 543-1858

    Fax: (610) 543-1862

    Lab Director : Jonathan Dao

    CLIA Number: 39D2205219

  • Should be Empty:
Jotform Logo
Now create your own JotForm - It's free! Create your own JotForm