St Christopher's Community COVID-19 Testing

03/10/2021 08:45 AM

Please fill out all the fields below. Items marked with an asterisk are required

Participant Info

Last Name *

First Name *

Middle Name

Date of Birth *

Parent/Guardian (if under 18)

Gender *

Race *

Ethnicity *

Contact *

Cell Phone

Address

Street *

Apt #

City *

State *

Zip Code *

Insurance

Health Insurance *

Testing is free for you, regardless of insurance or immigration status. When you give your insurance information, it allows the laboratory to bill your insurance to get reimbursed for the cost of the tests.

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