Business/Organization COVID Rapid Test Request Form
Please submit this form to request COVID-19 Rapid Tests for employee use in your business or organization. Please note that your allocation will depend on your number of employees and our current test kit supply. You are allowed at maximum one test kit per employee. The Health Department will call you when your order is ready and give you further instruction on where to pick up your tests.
Name of Person Submitting Form
Name of Business/Organization
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
Number of Employees
Number of COVID Test Kits Requested
Please note that your allocation will depend on your number of employees and our current testing supply. You are allowed at maximum one test per employee.
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