e-Signature & Consent:

By entering my name below (please enter name precisely as it appears on your Medicare or insurance card) I am signing my authorization to bill Medicare or my insurance carrier for 8 Covid tests. I represent that the information I entered above is accurate and that I am ordering these Covid tests strictly for my own personal use. I further represent that I will not resell Covid tests and that I am ordering them for the reasons I have stated on this website. Please enter your name below to Sign, Authorize and Consent to the Terms and Conditions, Privacy Policy and HIPAA Privacy Practices.

To Accept, please enter your Full Name with Middle Name or Initial precisely as it appears on your insurance card: