Form

  • Patient Information

  • Primary Care Provider

    If applicable please fill out the fields below; If not applicable please indicate "N/A" in the Physician Name Field.

  • For submitting facilities only

    Submitting Facility / Laboratory Information

  • Specimen Information

  • :
  • Test Performed

  • We accept HSA/FSA cards. Itemized bill provided for insurance reimbursement. If Pay Pal is not your preferred method of payment, please proceed with the "Pay with Debit or Credit Card" option. For any additional insurance, payment or scheduling questions, please feel free to call our Rapid Test Specialist at (201) 425-1583 for an immediate response.

    If testing for travel purposes, please consult with your airlines regarding requirements.

Contact Us

Corporate Location
541 Cedar Hill Avenue
Wyckoff, NJ 07481
Phone: 201-485-3092
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