• English
  • Español

1. Introduction & Attestation

  • Please use the form below to request your free At-Home Rapid COVID-19 Antigen Tests.
  • Please submit requests for antigen tests on an as-needed basis but no more than once a week per address.
  • Shipments are sent out twice a week but can take up to 2 weeks for delivery and are dependent on available inventory.
  • For At-Home Rapid COVID-19 Antigen Tests, you will be receiving an email from us with additional information and an estimated delivery date.
  • As of February 1, 2023, we are no longer distributing PPE.
  • We will do our best to fulfill full orders but ultimately it will depend on the supply available.

If you have a planned event where you would like to distribute antigen tests, please be sure to submit your request at least 3 weeks in advance.
Attestation

I understand this is an agreement between the Organization and DPH. To receive COVID-19 testing supplies at no cost for use by the community in which it is located, the Organization agrees that it will adhere to the following requirements:

  1. The Organization must not sell or seek reimbursement for the testing supplies provided at no cost to the Organization for this or any previous requests.
  2. The Organization must provide the tests regardless of the recipient's ability to pay administration or related fees or coverage status. The Organization may not seek, and will have never sought, any reimbursement from the test recipient, including through balance billing.
  3. The Organization must have processes to ensure timely and proper acceptance of testing supplies. Those processes must include, but are not limited to, procedures for accepting delivery through commercial delivery services.

Question Title

* 1. I attest that the Organization will agree to the above statements to be eligible for free antigen tests under DPH's distribution program.

Question Title

* 2. Enter the first and last name of the signer below, which will act as an e-signature affirming your attestation on behalf of the Organization.

 
 14% of survey complete.

T