Patient Information
If ordering a test for a minor: Please make sure the minor’s information is provided in the registration process, not your own.
existing
I’m an existing patient
First Name*
Middle Initial
Last Name*
Email*
Patients
We found multiple patients with this email. Please select the patient you are ordering the kit for.
Phone*

Home Address*
Apartment, Suite, Office
City*
State*
Zip*
has kit
I already have a kit
same address
Use home address as shipping address.
Shipping Address*
Apartment, Suite, Office
City*
State*
Zip*
Passport Information (for Travel)
using for travel
Are you using this for travel? (Check if yes)
Passport Number

Not all countries require a passport number but providing this will make it easier for you when boarding your flight.
Outgoing Shipping*
For faster delivery, please upgrade your outgoing shipping
Returns Shipping*
For faster returns, please upgrade your returns shipping
Note: Orders placed after 4PM EST. will be shipped the next day.

Do you have insurance?*
- Yes
- No
Reason for testing*
How did you hear about us?*
Date of Birth*
This information is needed for your test result PDF.
Gender*
This information is needed for your test result PDF.
Parent First Name
Parent Last Name
Insurance Company*
Subscriber / Member ID*
Insurance Company*
Group Number (Optional)
Are you the primary insurance member?*
- Yes
- No
You may upload your insurance card to speed up the verification process.
Insurance Card – Front (Optional)
Accepted file types: jpg, gif, png, Max. file size: 200 MB.
Insurance Card – Back (Optional)
Accepted file types: jpg, gif, png, Max. file size: 200 MB.
Hidden
Driver's License or ID Card (Front)
Accepted file types: jpg, gif, png, Max. file size: 200 MB.
Hidden
Driver's License or ID Card (Back)
Accepted file types: jpg, gif, png, Max. file size: 200 MB.
Hidden
same insurance address
Use home address as insurance provider address.
Hidden
Insurance Provider Address (if applicable)*
Hidden
Apartment, Suite, Office
Hidden
City*
Hidden
State*
Hidden
Zip*
Hidden
Phone*
Consent*
I understand that by submitting this order with my associated health insurance information, I consent to information about my testing and results being shared with the health insurer or government agency paying for my testing for purposes of payment, treatment, and/or healthcare operations, and as otherwise described in Fast Lab’s HIPAA & Privacy Policy.
Terms of Use and Privacy Policy*
I have read and accept Fast Lab Tech’s Terms of Use and Privacy Policy*
Acknowledgement*
By writing my name below, I acknowledge that the insurance details I have provided are correct and I can be billed the full amount for the test kit if my insurance details are found to be invalid.
Name*

Review Order
Please review your information below and ensure all information is correct before placing your order.

Important: The person named below must be the person who is taking the test
{all_fields:nohidden}

Outgoing Shipping
For faster delivery, please upgrade your outgoing shipping
Returns Shipping
For faster returns, please upgrade your returns shipping
Notes:
- Orders placed after 4PM EST. will be shipped the next business day.
- The 2-Day and Overnight shipping does not include weekends and holidays.
Total
$0.00
Payment*
Card Details
Cardholder Name
No. of PCR Tests*
No. of Antigen Tests*
same billing address
Use home address as billing address.
Hidden
Billing Address
Billing Address*
Apartment, Suite, Office
City*
State*
Zip*

Menu

Step 1 of 5

Patient Information

Passport Information (for Travel)

Review Order

Billing Address