At-Home COVID-19 Tests Request Form

Most insurance plans, including Medicare Part B, are covering the cost of up to 8 COVID-19 at-home tests per month for each person covered by insurance. Request yours online today and we will mail them directly to your home.

Note: Tricare will not cover these tests at this time.

Here's how it works:

1. Fill out this form requesting up to 8 COVID-19 tests.
2. We then will process your insurance claim for you so you don't have to pay out-of-pocket for your at-home COVID-19 Tests.
3. We will then ship them out!

Cushing Family Pharmacy supplies the iHealth COVID-19 tests, a FDA authorized antigen test that uses a nasal swab and delivers results in just 15 minutes.

Are you a current customer of Cushing Family Pharmacy?*

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If you are not already a customer, please complete our New Customer Form below so you will be automatically added in our system.

Please check the box below to confirm that you completed the New Customer Form*

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By completing this form, I have been informed that Section 6001 of the Families First Coronavirus Aid, Relief and Economics Security Act (FFCRA or CARES act) specifies that private health plans must cover certain OTC COVID-19 tests obtained without a prescription. I also understand that my insurance allows for 8 at home COVID test kits each month at my request. I acknowledge that I cannot use these tests for travel or employment purposes and should only use these kits in the event of a recent COVID exposure or when experiencing COVID related Symptoms. I understand that if I test positive for a COVID-19 infection today, I will be considered a probable positive and I will follow the current CDC guidelines for self-isolation and quarantine which can be found at www.CDC.gov/COVID19. If should contact my health care provider for additional testing and treatment. *