Order COVID-19 Test Kit

Eligibility
Lets determine if you are eligible for a test kit
Do you have a physician order?
Has a physician screened you and determined you need to be tested.
- Yes
- No - I need a telemedicine consult
A tele-medicine consultation will be provided to you to determine eligibility
Physician Information
Physician First and Last Name*
No Abbreviations. Complete first and last name must be provided.
Physician Phone Number*
Medical History
Fever or signs/symptoms of lower respiratory illness (e.g., cough or shortness of breath)
- Yes
- No
Select any one criteria that applies*
If more than one criteria apply, select any one
- Any person, including health care workers, who has had close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of symptom onset
- A history of travel from affected geographic areaswithin 14 days of symptom onset OR An individual(s) with risk factors that put them at higher risk or poor outcomes
- No source of exposure has been identified and other causes of respiratory illness have been ruled out (e.g., influenza)
- None of the above
At this time you are not eligible for testing. Testing criteria is being updated daily. Please visit this page back daily to see when testing for all persons will be available.

PATIENT INFORMATION
Name*
First Last
Date of birth*
MM slash DD slash YYYY
Phone*
Email*
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Eligibility