Test Schedule Form
Instructions
Instructions
Complete the following steps to schedule a test:
Select the test you wish to to have performed
Select the location where you would like to go to have your test sample collected
Select an available date and time for this collection
Fill out the remaining required fields on the form
If you wish to schedule a test for an additional person, click the
+ Add Person
button and repeat the above steps for the new form
When you are ready to schedule your test(s), click the
Next
button to go to the confirmation form
Test Information
Test:
Location:
Schedule Date/Time:
First Name:
Last Name:
Date of Birth:
Preferred Contact Method:
Email
Text
Email Address:
Cell Phone Number:
Do You Have Insurance?:
No
Yes
Insurance Information
No Insurance
Insurance Company:
Primary Insured:
Member ID:
Address 1:
Address 2:
City:
State:
Zip:
