Testing Appointment Form

Influenza Testing Appointment

Once you have arrived for your appointment, please pull into a space in front of the pharmacy and call us at 336-570-2273 to let us know you are here. One of our staff will come out and perform the test at your car. It will take 15 minutes to get the results. If you test positive for the flu we may dispense medication provided you meet certain criteria (symptoms for less than 48 hours,5 years old or older, normal BP, SpO2, kidney function, respiratory rate, and temperature under 102.
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Get Your Appointment
Name*

First NameLast Name
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
Primary care provider
Medication allergies*
Current medications (Rx and OTC)*
Unsure / NoMore than 2 days agoLess than 2 days ago
No symptoms2 days or lessmore than 2 days
If you have been experiencing symptoms for more than 48 hours, treatment with an antiviral agent will be of little to no benefit. We can proceed with testing to determine if you have COVID or Flu and advise on the best supportive care, and when to seek a higher level of care.
High feverCoughDifficulty breathingPersistent pain or pressure in the chestBody achesNasal congestionRunny noseSore throatDiarrheaNoneOther
5 - 1011 - 1920 - 4445 - 6465 - 7475 - 9090+
AnemiaAsthmaArthritisCancerGoutDiabetesEpilepsy SeizuresHeart DiseaseHeart AttackRheumatic FeverHigh Blood PressureDigestive ProblemsUlcerative ColitisHepatitisKidney DiseaseLiver DiseaseThyroid ProblemsTuberculosisVenereal DiseaseNeurological DisordersBleeding DİsordersLung Disease (Chronic Obstructive Pulmonary Disease)
YesNo
Patients with end stage renal disease (ESRD) on dialysis will need to follow up with their primary care physician. We can still perform the test to determine if you have COVID or the Flu but will be unable to provide treatment.
YesNo
YesNo
YesNo
YesNo
If you are currently taking or have taken an antiviral medication for the flu within the past 4 weeks, we will not be able to dispense any treatment today. We can proceed with testing to determine if you have COVID-19 or the Flu and advise on the best supportive care. We encourage you to follow up with your primary care provider.
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo

TESTING*

Influenza A/B Test

If treatment is appropriate, we can dispense Oseltamivir (Tamiflu) or Xofluza. Oseltamivir will be a $0 copay. Xofluza may incur an additional cost depending on insurance coverage.

$75.00 Quantity

Total

$0.00

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Influenza Testing Appointment

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