Call NOW !

(805) 608-4582

COVID-19 ANTIBODY/ANTIGEN TEST ORDER FORM

Due to high demand, Any orders received after 2pm PST Monday-Thursday will be handled the next day.
Any orders received on Friday after 12pm will be handled the next business day.

First Name

Last Name

Phone *

Email *

How did you hear about us?

Do you have any of the following symptoms?

Select the following

Have you tested positive for a SARS2-COV2 infection?

Are you an essential employee?

Are you pregnant?

Are you a high risk patient?

Were you in contact with someone that has been confirmed with SARS2-COV2 ?

To protect ourselves and our staff members, we must ship test kits to anyone who is experiencing symptoms, or has been in contact with someone who is, or has recently experienced symptoms. Will you be picking up, or should we ship to you?

How many people need to be tested?

At how many locations will testing be completed? Ex: 2 at home, 2 at a friends house, 3 at work etc. Please explain in as much detail as possible, it affects how we prepare the test kits.

Shipping Address

City

State

Postal code

Billing Address:

Price is $125 per test and $25 for shipping and handling. Administration in office or home by medical professional will be an additional $50 (SB county only) Your card will NOT be charged until we have spoken with you to confirm your order. Type of Credit / Debit Card to be used

Credit Card #

Expiration date

CVC / Security code

You will receive a call from our client service coordinator to confirm your order. Please check the box below to confirm the above information is correct

I confirm

Call NOW !

(805) 608-4582

COVID-19 ANTIBODY/ANTIGEN TEST ORDER FORM

Due to high demand, Any orders received after 2pm PST Monday-Thursday will be handled the next day.
Any orders received on Friday after 12pm will be handled the next business day.

Locate Us At:

533 E Micheltorena Street, Suite #203
Santa Barbara, CA 93103

Copyright 2021. Alright Reserved. AMI Santa Barbara. Privacy Policy.

Call NOW !

(805) 608-4582

COVID-19 ANTIBODY/ANTIGEN TEST ORDER FORM

Due to high demand, Any orders received after 2pm PST Monday-Thursday will be handled the next day. Any orders received on Friday after 12pm will be handled the next business day.

Locate Us At:

533 E Micheltorena Street, Suite #203 Santa Barbara, CA 93103

Copyright 2021. Alright Reserved. AMI Santa Barbara. Privacy Policy.

Due to high demand, Any orders received after 2pm PST Monday-Thursday will be handled the next day.
Any orders received on Friday after 12pm will be handled the next business day.

533 E Micheltorena Street, Suite #203
Santa Barbara, CA 93103