Hudson Medical Group

COVID-19 Test Kit Order Form PHASE 6

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Personal Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Screening Information

Are you currently experiencing symptoms? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Previous Tests

Have you been previously diagnosed with COVID-19 via other testing methods? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What was the result of the test? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you had symptoms in the past? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Information

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Payment Form

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

COVID-19 Test Options

Please select a test option: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Special Bundles: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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COVID-19 PCR Test Options:
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Same-Day Results: +$50 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Same-day results is only for in-person nasal swab.

Same-day results are only available for morning appointments.

The COVID-19 PCR detects active SARS-CoV-2 virus in individuals experiencing symptoms of COVID-19.

The lab will run and analyze your test once it is received, and within 48-72 hours will inform you of your results.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

All take-home COVID-19 PCR kits include a shipping label and can be stored for future use.

You will receive a link in your confirmation email to schedule a time to pick up your test kit at our Tribeca location.
Same-day appointments & walk-ins are welcome.

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COVID-19 Antibody Test Information

COVID-19 Antibody testing determines whether you had COVID-19 in the past and now have antibodies against the virus.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

Rapid Antigen Test Information

The Rapid Antigen Test provides results diagnosing an active coronavirus infection.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

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COVID-19 Test Options

Please select a test option: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Special Bundles: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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COVID-19 PCR Test Options:
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Same-Day Results: +$50 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Same-day results is only for in-person nasal swab.

Same-day results are only available for appointments before 2pm.

The COVID-19 PCR detects active SARS-CoV-2 virus in individuals experiencing symptoms of COVID-19.

The lab will run and analyze your test once it is received, and within 48-72 hours will inform you of your results.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

All take-home COVID-19 PCR kits include a shipping label and can be stored for future use.

You will receive a link in your confirmation email to schedule a time to pick up your test kit at our Tribeca location.

Same-day appointments & walk-ins are welcome.

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COVID-19 Antibody Test Information

COVID-19 Antibody testing determines whether you had COVID-19 in the past and now have antibodies against the virus.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

Rapid Antigen Test Information

The Rapid Antigen Test provides results diagnosing an active coronavirus infection.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

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COVID-19 Vaccine

Hudson Medical + Wellness is registered as a Vaccination Center with NYS. Priority will be given to our patients first that meet the criteria.

More information to come when these are available.

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Billing Information

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{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}
{# pageNumbers}
Hudson Medical Group

COVID-19 Test Kit Order Form PHASE 6

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{{ Cognito.resources['order-billing-info-header'] }}

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{{ Cognito.resources['order-amount-paid'] }}:({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:{binding displayValue}
Hudson Medical Group

COVID-19 Test Kit Order Form PHASE 6

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{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
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{{ Cognito.resources['order-billing-info-header'] }}

{binding BillingName}
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Personal Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Referral Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Screening Information

Are you currently experiencing symptoms? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Previous Tests

Have you been previously diagnosed with COVID-19 via other testing methods? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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What was the result of the test? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Test {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you had symptoms in the past? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of First Symptoms {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Information

Do you have insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance ID {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Payment Form

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

COVID-19 Test Options

Please select a test option: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Special Bundles: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
COVID-19 PCR Test Options:
COVID-19 Test Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Same-Day Results: +$50 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Same-day results are only available for morning appointments.

The COVID-19 PCR detects active SARS-CoV-2 virus in individuals experiencing symptoms of COVID-19.

The lab will run and analyze your test once it is received, and within 48-72 hours will inform you of your results.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

All take-home COVID-19 PCR kits include a shipping label and can be stored for future use.

You will receive a link in your confirmation email to schedule a time to pick up your test kit at our Tribeca location.
Same-day appointments & walk-ins are welcome.

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COVID-19 Antibody Test Information

COVID-19 Antibody testing determines whether you had COVID-19 in the past and now have antibodies against the virus.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

Rapid Antigen Test Information

The Rapid Antigen Test provides results diagnosing an active coronavirus infection.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

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COVID-19 Test Options

Please select a test option: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Special Bundles: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
COVID-19 PCR Test Options:
COVID-19 Test Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Same-Day Results: +$50 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Same-day results are only available for appointments before 2pm.

The COVID-19 PCR detects active SARS-CoV-2 virus in individuals experiencing symptoms of COVID-19.

The lab will run and analyze your test once it is received, and within 48-72 hours will inform you of your results.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

All take-home COVID-19 PCR kits include a shipping label and can be stored for future use.

You will receive a link in your confirmation email to schedule a time to pick up your test kit at our Tribeca location.

Same-day appointments & walk-ins are welcome.

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COVID-19 Antibody Test Information

COVID-19 Antibody testing determines whether you had COVID-19 in the past and now have antibodies against the virus.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

Rapid Antigen Test Information

The Rapid Antigen Test provides results diagnosing an active coronavirus infection.

You will receive a link in your confirmation email to schedule a time for your test at our Tribeca location.

Same-day appointments & walk-ins are welcome.

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COVID-19 Vaccine

Hudson Medical + Wellness is registered as a Vaccination Center with NYS. Priority will be given to our patients first that meet the criteria.

More information to come when these are available.

Subscribe {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Billing Information

Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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