Phone: 307.367.2278 | FAX: 307.367.3563

COVID-19 Antibody Testing Screening and Consent Form

This Test is intended to expand access to COVID-19 risk screening. This test DOES NOT diagnose infection. It is not intended for people experiencing symptoms or who may need more immediate medical care. Please visit the CDC website for information on what do do if you are at risk.
  • Date Format: MM slash DD slash YYYY
    **If you are pregnant, you DO NOT qualify for this test. Consult your physician for testing options.
  • In the field above, type your first and last name. This will serve as your electronic signature.
    By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature and that it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
  • Price: $95.00
    When form is submitted, you will be redirected to PayPal to complete payment.