COVID-19 BOOKING FOR TESTING SITE

THIS FORM MUST BE FILLED OUT FOR ANYONE WHO IS GETTING TESTED

Form for Insured Clients

Testing Location

Date of Birth

First Name

Last Name

Sex

Street Address

Street Address Line 2

State

City

Country

Zip code

Phone Number

Insurance Plan Name

Insurance Member ID

Picture of Insurance Card (FRONT)

Upload File

Picture of Insurance Card (BACK)

Upload File

PICK A DATE AND TIME THAT CORRESPONDS TO OUR HOURS,
OR JUST WALK IN TO OUR ELLICOTT CITY LOCATION

Select a date

Appointment Time

Choose a time

Hours:

Monday - Friday: 9:00am – 5:00pm

Saturday: 10:00am – 3:00pm (Only Ellicott City Location)

Sunday: Closed

COVID-19 BOOKING FOR TESTING SITE

THIS FORM MUST BE FILLED OUT FOR ANYONE WHO IS GETTING TESTED

Form for Uninsured Clients

Testing Location

Date of Birth

First Name

Last Name

Sex

Street Address

Street Address Line 2

State

City

Country

Zip code

Phone Number

Social Security Number

Picture of Drivers License (FRONT)

Upload File

Picture of Drivers License (BACK)

Upload File

PICK A DATE AND TIME THAT CORRESPONDS TO OUR HOURS OR JUST WALK IN TO OUR ELLICOTT CITY LOCATION

Select a date

Appointment Time

Choose a time

Hours:

Monday - Friday: 9:00am – 5:00pm

Saturday: 10:00am – 3:00pm (Only Ellicott City Location)

Sunday: Closed

FHC COVID-19 TESTING SERVICES

COVID-19 BOOKING FOR TESTING SITE

Form for Insured Clients

PICK A DATE AND TIME THAT CORRESPONDS TO OUR HOURS,
OR JUST WALK IN TO OUR ELLICOTT CITY LOCATION

COVID-19 BOOKING FOR TESTING SITE

Form for Uninsured Clients

PICK A DATE AND TIME THAT CORRESPONDS TO OUR HOURS OR JUST WALK IN TO OUR ELLICOTT CITY LOCATION

6340 Security Blvd, Baltimore, MD, 21207

9636 Fort Meade Rd, Laurel, MD 20707

9055 Chevrolet drive ste 205 Ellicott city, MD, 21042

FHC COVID-19 TESTING SERVICES

COVID-19 BOOKING FOR TESTING SITE

Form for Insured Clients

PICK A DATE AND TIME THAT CORRESPONDS TO OUR HOURS, OR JUST WALK IN TO OUR ELLICOTT CITY LOCATION

COVID-19 BOOKING FOR TESTING SITE

Form for Uninsured Clients

PICK A DATE AND TIME THAT CORRESPONDS TO OUR HOURS OR JUST WALK IN TO OUR ELLICOTT CITY LOCATION

PICK A DATE AND TIME THAT CORRESPONDS TO OUR HOURS,
OR JUST WALK IN TO OUR ELLICOTT CITY LOCATION