Sacred Heart Church

St. Leo’s Church 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 in a vehicle and 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.

St. Leo’s Church

324 Market Street, Elmwood Park, NJ 07407

201‐796‐3521

 

COVID-19 Testing,
Saturday, January 30, 2021 – 09:00 am – 4:00 pm

Name DateTime Action
 St. Leo’s ChurchSaturday, January 3009:00 AM to 09:30 AMCheck Availability
 St. Leo’s ChurchSaturday, January 3009:30 AM to 10:00 AMCheck Availability
 St. Leo’s ChurchSaturday, January 3010:00 AM to 10:30 AMCheck Availability
 St. Leo’s ChurchSaturday, January 3010:30 AM to 11:00 AMCheck Availability
 St. Leo’s ChurchSaturday, January 3011:00 AM to 11:30 AMCheck Availability
 St. Leo’s ChurchSaturday, January 3011:30 AM to 12:00 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3012:00 PM to 12:30 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3012:30 PM to 01:00 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3001:00 PM to 01:30 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3001:30 PM to 02:00 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3002:00 PM to 02:30 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3002:30 PM to 03:00 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3003:00 PM to 03:30 PMCheck Availability
 St. Leo’s ChurchSaturday, January 3003:30 PM to 04:00 PMCheck Availability

Wellcare COVID-19 Testing Service

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