Bernards Township COVID-19 Testing Registration Form

Bernards Township COVID-19 Testing Registration Form

 

Please fill out the following information to complete your registration. With medical insurance, there is no cost to you for the COVID-19 test. We will only perform diagnostic medical services covered by your medical insurance. You will receive a statement from your insurance company – an explanation of Benefits (EOB) – which will itemize the services received, but it is not a bill. At this time, we are not able to support self-pay registrations.

Please note that all participants are required to arrive at the test location wearing a mask during your scheduled date and time. For support with this form only, contact wellcarecovidtesting@gmail.com.

 

Save Time In LineDownload and fill out these 2 forms and bring them along with you to your test.

1. Assignment of Benefits Form [PDF]
2. Covid Specimen Intake Form [PDF]

Uninsured, Please Note:

Due to the lack of sufficient funding for the HRSA COVID-19 Uninsured Program, our COVID-19 testing clinics will bill individuals without health insurance $75 per COVID-19 test.

Bernards Township Community Center

289 South Maple Avenue, Basking Ridge, NJ 07920

908‐204‐2520

 

COVID-19 Testing – Walk-Up Event
Tuesday, January 11, 2022 ‐ 9 am – 4:00 pm

Please note: The time slot 9:00 am – 9:30 am is reserved for Bernard’s First Responders only.

Note: Please check to make sure all fields are filled out. If you click the Submit button and nothing happens scroll back up and look for any fields that are missing your information. They will be highlighted in red. Fill them in and then click the submit button afterward and your registration form will go through and a message will display afterward confirming we received it.

2-STEP REGISTRATION PROCESS 

You must complete both steps 1 & 2 to receive your free Covid test:

STEP 1 - First, Reserve Your Time Slot For This Covid Test. Select a time below by clicking "Book me"

STEP 2 - Then complete this Patient Registration lab form for this Covid Test by clicking the button below:

Name DateTime Action
BERNARDSTuesday, January 1109:00 AM to 09:30 AMCheck Availability [First Responders Only]
BERNARDSTuesday, January 1109:30 AM to 10:00 AMCheck Availability
BERNARDSTuesday, January 1110:00 AM to 10:30 AMCheck Availability
BERNARDSTuesday, January 1110:30 AM to 11:00 AMCheck Availability
BERNARDSTuesday, January 1111:00 AM to 11:30 AMCheck Availability
BERNARDSTuesday, January 1111:30 AM to 12:00 PMCheck Availability
BERNARDSTuesday, January 1112:00 PM to 12:30 PMCheck Availability
BERNARDSTuesday, January 1112:30 PM to 01:00 PMCheck Availability
BERNARDSTuesday, January 1101:00 PM to 01:30 PMCheck Availability
BERNARDSTuesday, January 1101:30 PM to 02:00 PMCheck Availability
BERNARDSTuesday, January 1102:00 PM to 02:30 PMCheck Availability
BERNARDSTuesday, January 1102:30 PM to 03:00 PMCheck Availability
BERNARDSTuesday, January 1103:00 PM to 03:30 PMCheck Availability
BERNARDSTuesday, January 1103:30 PM to 04:00 PMCheck Availability

Wellcare COVID-19 Testing Service

WellCare provides New Jersey Municipalities and Institutions with free COVID-19 Testing Services.