Covid | AmeriMed

Click HERE for Company Partner Program Information!!!

First Name

Date of Birth

Last Name

Mobile Phone

Address

Primary Insured

Insurance Carrier

Cardholder ID

Verify Cardholder ID

BIN

Group

PCN

(Optional) Upload Photo of Insurance Card

Upload File

Upload supported file (Max 15MB)

Do you have additional Family members you like to order test for?

Yes

Spouse First Name

Spouse Last Name

Spouse Date of Birth

Spouses Address

Child 1 First Name

Child 1 Date of Birth

Child 1 Last Name

Child 1 Address

Child 2 First Name

Child 2 Last Name

Child 2 Date of Birth

Child 2 Address

Child 3 First Name

Child 3 Last Name

Child 3 Date of Birth

Child 3 Address

Child 4 First Name

Child 4 Last Name

Child 4 Date of Birth

Child 4 Address

GET DIRECTIONS