Upon Arrival for Your COVID-19 Rapid Test, Please Fill Out This Screening Form and Submit It Before Your Test is Taken. 

Call (908) 452-5612 when you have finished the screening and are waiting in the car, ready for your COVID-19 Test.

COVID-19 Screening

COVID-19 Screening

Please complete this form before getting a COVID-19 test.

Age 3-15: A parent or legal guardian needs to fill out this form and accompany the patient to visit.
Age 16-17: A parent or legal guardian needs to fill out this form.

All fields are required unless marked as optional.

Have you experienced any of these symptoms? (Select any that apply) *
Do you have any of the following medical conditions? (Select any that apply) *
How Did You Hear About Us? *
I acknowledge that I have answered these questions truthfully to the best of my knowledge. I understand that I must perform my own nasal swab or bring someone to do it for me. *