Get an Appointment or Ask a Question Full Name* Phone (U.S. number for faster response)* Email Address* Date of Birth MM/DD/YYYY* Street Address Zip Code Insurance (HMO, PPO, or MEDICAID) Appointment Date Requested Appointment Time Requested Passport Number Are you a new patient? Are you a new patient? Yes No Gender Gender Male Female unspecified QR Code for Additional Fee QR Code for Additional Fee Yes No Not testing for COVID Reason for COVID Test Reason for COVID Test Not testing for COVID-19 Experiencing symptoms Going on a cruise International travel Other (indoor activities, work, and etc...) What COVID test do you need? What COVID test do you need? RAPID Antigen RT-PCR Not Sure Reason for visit and anything else we should know. Submit