Patient Registration

Information that we will need:

Date and Time
Pick a time slot that works for you
What is your cell phone number?
What is your address?
Select state
    No Identification source
    Driver's License
Please note: Only the following file types will be accepted: .jpg, .png, .bmp, .gif.
On March 15th, 2022, the US Health Resources & Services Administration (HRSA) announced that it would no longer be funding COVID-19 testing or treatments. As a result, all of’s COVID-19 services will now be billed through your insurance provider. Patients who are uninsured will be charged a reduced fee of $49.00 for the test sample collection with a care provider, payable by debit or credit as part of the booking process.
  • Please note: Only the following file types will be accepted: .jpg, .png, .bmp, .gif.
  • $49.00

By placing my signature below, I certify that the information on this patient registration is correct and I fully understand and agree with the following:

Cost of visit

Some same-day appointments may include a delivery fee in order due to high demand in the area.

Covid-19 test
Total cost $0.00
Payment is available after verification

Long Haul Covid. How it works: 1. Schedule Appointment: Please ensure that it has been at least four weeks since your first positive COVID test before you book an appointment for long haul COVID. Once you have confirmed the date of your positive test, you can book your appointment here. You will need to provide your personal and insurance information to complete your booking. 2. Check-In: Log in to the app and check in 15 minutes before your appointment. You will be asked to confirm your information and appointment details with the virtual front desk. 3. Start appointment: Meet with one of our providers through video via the telemedicine link. 4. Get Treatment: Following the appointment, log in to the app to review any next-steps submitted by the provider. For more inquiries, please contact: +1 (888) 215-6182.