Walk-In Cash Pay

Name of Payer *

First

Last

Email *

Testing Location *

Test *

Please Note: The Anti-Body Test are only available at the PSC Wilton, PSC Bridgeport, and PSC Shelton Trap Falls Road locations.

Number of Patients *

For COVID-19 Test.

Number of Patients *

For COVID-19 Test.

Number of Patients *

For COVID-19 Test.

Number of Patients *

For FLU Test.

Number of Patients *

For RSV Test.

Number of Patients *

For COVID-19 and FLU Combined.

Number of Patients *

For COVID-19, FLU, and RSV Combined.

Please enter each Patients Name *

Total

$ 0.00

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