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2001 E. First St Suite 109
Santa Ana, CA 92705
Tel: 833-668-2522 Fax: 833-668-2329
Lab Director: Rosaura Williams, MD
CLIA #: 05D0871568
PATIENT IDENTIFICATION
WITHOUT PROPER IDENTIFICATION, TESTING CANNOT BE PERFORMED. ATTACH A COPY OF IDENTIFICATION PLEASE.
Identification type:
(Driver License, Passport, Identification Card, etc)

Patient Information

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Ethnicity / 人种

PAYMENT INFORMATION

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DISCLAIMER: By signing below, the patient is aware of the following:

This test has been validated by Nova Diagnostics Laboratories and utilizes the FDA approved method under the Emergency Use Authorization (EUA). Molecular diagnostic testing by PCR should be considered to rule out infection at the time of collection. The COVID-19 molecular diagnostic test relies on the accurate collection of the specimen; improper collection may compromise the outcome of the test results.

Test results will only be delivered by the method indicated by the patient; if the results are to be emailed to the patient, patient signature is required. Nova Diagnostics Labs strictly follows HIPAA guidelines and will only send the test results by the method the patient chooses, as indicated above.

All patients’ COVID-19 test results will be reported to the California Department of Public Health (according to CDC guidelines).

“Results You Can Trust”