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ALLEN W. ROBERTS SCHOOL
WEEKLY COVID-19 TESTING COMPLETED BY ADVANCED MANAGEMENT SERVICES
*PLEASE NOTE; HORIZON BLUE CROSS BLUE SHIELD WILL NO LONGER COVER POPULATION TESTING
FOR COVID-19. IF YOU GET TESTED YOU WILL RECEIVE A BILL*
TESTING DETAILS:
LOCATION: 80 JONES DRIVE NEW PROVIDENCE NJ 07974
TIME & DATE : SATURDAY TESTING BEGINNING 9/18/21 -8AM-10AM
CDC GUIDLEINES WILL BE ENFORCED
MASKS & SOCIAL DISTANCING REQUIRED
PLEASE BRING A COPY OF YOUR INSURANCE CARD
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Email
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Your email
FULL NAME OF PERSON BEING TESTED
Your answer
COMPLETE ADDRESS OF PERSON BEING TESTED
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DATE OF BIRTH OF PERSON BEING TESTED
MM
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DD
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YYYY
TELEPHONE NUMBER OF PERSON BEING TESTED
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TYPE OF INSURANCE FOR PERSON BEING TESTED
*
I UNDERSTAND IF I HAVE HORIZON & GET TESTED - I WILL RECEIVE A BILL
AETNA
MEDICARE
MEDICAID
OTHER (SEE BELOW)
NO INSURANCE
Required
IF YOU SELECTED OTHER - TYPE INSURANCE NAME BELOW
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INSURANCE CARD NUMBERS
*
Your answer
(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.
I ACKNOWLEDGE THAT I AM UNDOCUMENTED OR UNINSURED.
IN THE BOX THAT ASKS FOR INSURANCE CARD NUMBERS, PLEASE TYPE COVID-19
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