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Milart Pharmacy
300 S. Beverly Drive #100
Beverly Hills, CA 90212
rx@milartrx.com
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Wedding COVID Testing
Insured and Uninsured
(PCR and Rapid Antigen)
Please Fill Out The Form Below
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Do you have insurance? In the next section: If Yes, Upload your insurance card. If NO, upload your ID.
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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.
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NAME OF PARTY or BRIDE/GROOM)
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