If you have remaining questions, please call us at (316)788-6669.
If you would like online access to your PCR results, please enter a valid email address and choose a 4-digit PIN.
Section I. Personal Information
Section IV. Signature
By signing this form, I give consent for Derby Drug to send my testing results to the Kansas State Department of Health and Welfare.
By clicking the "Submit" button below, you certify that the above information is correct and accurate to the best of your knowledge. All information is confidential and is accessed only via a secure, encrypted interface.