COVID Tests

At-Home COVID Tests — Complete the form below to get your COVID tests.

Up to 8 Tests per Person Monthly

In April 2022, the Biden Administration made it mandatory for commercial insurance and Medicare to cover the cost of at-home tests.

First Name

Last Name

Address

Phone

Date of Birth

# of Tests Requested

Shipped Monthly

YesNo

Additional Family Members Requesting Tests

SpouseChild

Authorization & Consent

I represent that I am ordering the Tests for personal use, and not for employment purpose or for resale or donation to others.

I have not ordered similar or the same tests this month from any other healthcare provider covered by my Insurer.

I understand that my Insurer may limit the number of Tests covered per month, and that by ordering from another source, I may not have coverage for the Tests.

I hereby authorize and direct, to the fullest extent covered, my health insurer or other healthcare benefit program to pay my provider all amounts due and owing for the at-home COVID test kits ordered by me or on my behalf.

I acknowledge that the Provider has a no-return policy and I fully understand that I may be directly responsible to pay the Provider for the Tests, less any amounts paid by my Insurer.

I have read and agree to the above authorization and consent terms.

Give us a call:

480-946-9477