Mako Medical

Location: GA- Luetta Moore Park

525 Martin Luther King Dr, Statesboro GA 30458, US

Monday & Wednedsay 8AM-3PM, Tuesday & Thursday 10AM-6PM Friday 9AM-4PM. 2nd & 4th Saturday each month 8:30AM-12:30PM

Patient Information

First Name

Middle

Last Name

DOB

Sex

Race

Ethnicity

Phone Number

Social Security Number

Driver License/State ID Number

Address

Address 2

City

State

Zip Code

Payment Options

I have insurance No insurance

Attestation

A SSN and state of residence, or state identification / driver's license is needed to verify patient eligibility. I attest that I do not have this information at the time of service and will not be providing it.

Insurance

Insurance not listed

Policy Number

Group Number

Custom State Required Questions

1. Is this the first COVID19 test you've had?

Yes No Unknown

2. Are you currently employed in healthcare?

Yes No Unknown

3. Hospitalized?

Yes No Unknown

4. ICU?

Yes No Unknown

5. Resident in a congregate care setting (including nursing homes, residential care for people with intellectual and developmental disabilities, psychiatric treatment facilities, group homes, board and care homes, homeless shelter, foster care or other setting):

Yes No Unknown

6. Are you currently pregnant?

Yes No N/A

7. Symptomatic as defined by CDC?

According to the CDC:
People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

Yes No Unknown

Date of Symptom Onset:

Register for Testing

Location: GA- Luetta Moore Park

525 Martin Luther King Dr, Statesboro GA 30458, US

Patient Information

Payment Options

Attestation

Custom State Required Questions