IMHOTEP INSTITUTE CHARTER HIGH SCHOOL
6201 N. 21ST STREET
PHILA PA 19138

TESTING DATES :
WEDNESDAYS -
1/12 2PM-5PM
1/19 - 10AM-3PM
1/26 - 10AM-3PM

TESTING TIME: 10AM-3PM

MASK AND SOCIAL DISTANCING REQUIRED
BRING A COPY OF YOUR INSURANCE CARD

(APPT TIMES THAT DO NOT APPEAR ARE FULL)

(PARENTAL CONSENT IS REQUIRED FOR ALL STUDENTS AND MINORS)


For further information Email
covidtesting92@gmail.com
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Email *
NAME OF PERSON BEING TESTED *
ADDRESS PERSON BEING TESTED *
PHONE NUMBER OF PERSON BEING TESTED *
DATE OF BIRTH OF PERSON BEING TESTED *
INSURANCE INFORMATION OF PERSON BEING TESTED *HORIZON BLUECROSS BLUESHILD IS NO LONGER COVERING POPULATION TESTING* *
Required
INSURANCE CARD NUMBERS OF PERSON BEING TESTED *
 (WARNING) IF A PERSON HAS INSURANCE BUT STATES THEY ARE UNINSURED OR UNDOCUMENTED, THE FEDERAL CARES ACT WILL NOT PAY FOR THE TEST AND YOU WILL BE BILLED! IF YOU'RE UNINSURED OR UNDOCUMENTED, PLEASE PROCEED.
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