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Patient Information

Email*

First Name*

Last Name*

Patients

We found multiple patients with this email. Please select the patient for the order.

If ordering a test for a minor: Please make sure the minor’s information is provided in the registration process, not your own.

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Race*

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Ethnicity*

Parent First Name*

Parent Last Name*

Insurance Company*

Please enter your Insurance Company*

Subscriber / Member ID*

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Group Number (Optional)

No. of Antigen Tests*

You may upload your insurance card to speed up the verification process. There may be a 2 to 3 day delay in verifying your insurance if you don't upload your ID.

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Insurance Card - Front (Optional)

Accepted file types: jpg, gif, png, jpeg, Max. file size: 200 MB.

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Insurance Card - Back (Optional)

Accepted file types: jpg, gif, png, jpeg, Max. file size: 200 MB.

To complete your order, you will need to have a consultation with a medical provider. Our preferred medical partner is Fast Doc.

Preferred consultation method*

Phone Call

Video

Audio

Please make sure to answer the phone call you'll receive in a few minutes.

In light of the upcoming holiday, all orders approved by our providers on and after Friday, November 22nd, may be resulted after Thanksgiving, November 28th

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Patient Information