COVID-19 Test Registration



Saliva PCR Test
Rapid Antigen Test
Rapid Antibody Test
(6 to 8 alphabets and numbers, no special symbols)
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(e.g. Passport picture page, driver's license, etc. Change your camera/photo settings to files of max file size of 6MB and image types of JPG, PNG, or PDF.)
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Insurance     No Insurance
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No     Yes

Yes     No

Yes     No


You have consented to a diagnostic test for SARS-CoV-2 (COVID-19) collected by COVID Diagnostics. If submitting a saliva sample for PCR testing, your sample will be sent to a laboratory for testing, and that laboratory will provide you with the results. You should expect results within approximately 72 hours. If you are submitting a nasal sample for rapid antigen testing, or a fingerprick blood specimen for rapid antibody testing, your results will be available within 2 hours. When your results are available you will receive an email via the email address we have on file. Please verify this email address is correct. You will then be able to access your tests results directly through the patient portal.

Please refer to our web page for information about the individual tests and what the results mean. Please keep in mind that SARS-CoV-2 (COVID-19) diagnostic tests are not perfect. No test is. If they were perfect, a positive test would mean that someone carries the virus and a negative test means that they do not. There is a small percentage of tests that could be falsely positive or falsely negative. Thus, we ask that you consider risk factors and individual scenarios and not completely rely on the test results to choose your behavior. COVID DIAGNOSTICS WILL NOT OFFER ANY MEDICAL CARE OR TREATMENT RELATED TO COVID-19. IN THE EVENT YOUR TEST RESULT IS POSITIVE AND/OR YOU EXPERIENCE SYMPTOMS OF COVID-19, YOU SHOULD SEEK MEDICAL ATTENTION FROM AN EMERGENCY ROOM OR YOUR HEALTH CARE PROVIDER IMMEDIATELY.

BY SIGNING BELOW, YOU ACKNOWLEDGE THE ABOVE AND AGREE TO THE SPECIMEN COLLECTION AND TESTING PROCESS AS DESCRIBED. YOU UNDERSTAND THAT COVID DIAGNOSTICS WILL NOT PROVIDE ANY TREATMENT OR MEDICAL CARE RELATED TO COVID-19 AND AGREE TO SEEK MEDICAL TREATMENT IN THE EVENT OF A POSITIVE TEST RESULT OR IF YOU BEGIN TO EXPERIENCE COVID-19 SYMPTOMS. YOU FURTHER ACKNOWLEDGE THAT COVID DIAGNOSTICS MAY BE REQUIRED TO REPORT A POSITIVE TEST RESULT BY LAW. YOU UNDERSTAND THAT WITH ANY TEST THERE IS THE POSSIBILITY OF A FALSE POSITIVE OR FALSE NEGATIVE RESULT. TO THE FULLEST EXTENT OF THE LAW YOU HEREBY RELEASE, DISCHARGE AND HOLD HARMLESS COVID DIAGNOSTICS, AND ITS MEMBERS, MANAGERS, DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS, FROM ANY AND ALL CLAIMS, LIABILITY AND DAMAGES, OF WHATEVER KIND OR NATURE, ARISING OUT OF, OR IN CONNECTION WITH, ANY ACT OR OMISSION RELATING TO YOUR COVID-19 TEST (INCLUDING SPECIMEN COLLECTION) OR THE DISCLOSURE OF YOUR COVID-19 TEST RESULTS, AS WELL AS ANY CONSEQUENCES THEREFROM, WHETHER EXPECTED OR UNEXPECTED. YOU AGREE TO PAY FOR THE COST OF SERVICES PROVIDED BY COVID DIAGNOSTICS IN FULL PRIOR TO SPECIMEN COLLECTION. YOU ACKNOWLEDGE THAT COVID DIAGNOSTICS WILL NOT SUBMIT A CLAIM FOR REIMBURSEMENT TO ANY THIRD-PARTY OR ASSIST YOU IN MAKING SUCH A CLAIM, AND THERE IS NO GUARANTEE A THIRD-PARTY WILL REIMBURSE YOU FOR ANY COSTS ASSOCIATED WITH THIS TEST. YOU UNDERSTAND THAT THE LABORATORY CONDUCTING THE TESTING MAY BILL YOUR INSURANCE OR THIRD-PARTY PAYOR FOR ITS SERVICES. YOU HAVE READ AND UNDERSTAND THE DOCUMENT TITLED “UNDERSTANDING YOUR COVID-19 TEST RESULTS.” YOU AGREE THAT YOU HAVE BEEN GIVEN AN OPPORTUNITY TO ASK QUESTIONS REGARDING THIS AUTHORIZATION AND HAVE HAD SUCH QUESTIONS ANSWERED TO YOUR SATISFACTION.
Accept