SARS-CoV-2 ANTIGEN TEST DOCUMENT REQUEST

Name: Pediatric People
Price range: $

SARS-CoV-2 ANTIGEN TEST DOCUMENT REQUESTMichael2020-07-12T12:07:25-05:00

Patient's Name*
First Last
Patient's Date of Birth*
Date of Test*
MM slash DD slash YYYY
What document(s) do you need?*
- Select All
- Test results
- Statement to return to work, school or daycare
Delivery Email*
I understand and agree that this authorization allows Pediatric People, PLLC to send an email regarding test results, appointments, referrals, billing or other information regarding your care.