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At-Home COVID TEST REQUEST FORM
Please fill out the form in it's entirety. Please note that if we do not have your current insurance on file we may not be able to successfully process the tests and due to the high volume of requests will not be able to reach out to gather that information. If you believe your insurance has changed please bring that information with you when you come to pickup your tests. We will dispense iHealth or FlowFlex tests based on availability. 
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    We are currently out of FlowFlex tests. Our next shipment should arrive Thursday May 26th in the morning. Please continue to fill out this form and we will process your order as soon as they arrive.

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    You will only need to submit credit card information if you elect to have your tests mailed. Pickup is selected by default, to select mail, click the blue plus sign.
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