North Texas Rapid PCR | Covid Testing Registration

Select Tests

Insurance Services

SARS-CoV-2 PCR Nucleic Acid (Covid-19) - Covered

Urinary Tract Infection - Coverage varies by insurance

Wound PCR Panel - Coverage varies by insurance

Comprehensive Upper Respiratory - Medicare B only

Pre-Pay Services

SARS-CoV-2 PCR Nucleic Acid (Covid-19) $180.00

Comprehensive Upper Respiratory $640.00

Urinary Tract Infection $500.00

Wound PCR Panel $550.00

Respiratory Light (Covid, Flu A & B, RSV, Strep) $250.00

Having Symptoms Clearance for Travel General Screening

Are you a previous patient?

No Yes

First Name

Last Name

Middle Initial

Social Security Number

Street Address

City

State

Zip

Gender at Birth

DOB

Cell Phone Number

Email

Passport Number

Race

Ethnicity

Last Name

First Name

Relation to Patient?
Self Parent Spouse

Insurance Company Name

Member ID

Group #

INSERT INSURANCE CARD AND PHOTO ID PICTURES

(Insurance and ID Cards also required at appointment)

By clicking the buttons below, you will be prompted to insert a photo of both the patient current insurance card and photo ID. The photos can be taken with your tablet or phone if you are using those to fill in this form.

To speed up your results and processing time please upload photos of your insurance information below.

Insurance Card Front Photo

Insurance Card Back Photo

ID Card Front Photo

ID Card Back Photo

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