COVID-19 At-Home Test Kit Survey

Please select the option that is right for you.

Kits are available for $0 upfront cost for individuals with insurance who complete a short survey and meet clinical testing guidelines. For those who are uninsured, do not wish to take the survey, or do not meet clinical testing guidelines, kits are available for purchase.  

Please describe the option that best describes your symptoms:

If you have both severe and mild symptoms, select severe.

Have you been exposed to the coronavirus in the past 2 weeks?

Please select the option that most closely describes your level of exposure:

Do any of the following statements apply to you?

Please select the first option if ANY of these apply to you: