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300 S. Beverly Drive #100
Beverly Hills, CA 90212
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Friends Club COVID Testing
Insurance, No Insurance and Payment
Please Fill Out The Form Below
PCR TEST, RAPID ANTIGEN OR BOTH
PCR, RAPID ANTIGEN OR BOTH
Date of Birth
Do you have insurance? In the next section: If Yes, Upload your insurance card. If NO, upload your ID.
yes or no
If you have US Insurance, Upload photo of the front of insurance card. If you do not have US insurance, upload photo of your ID.
Upload photo of health insurance card or ID
Upload supported file (Max 15MB)
DATE for the Test?
TIME for the Test?
NAME OF LOCATION
Thanks for submitting!
We have received your information.
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