Please complete this request form

Requests should be made once per month. Each household will receive 2 test kits (total of four tests). Requests must be from residents of Howard County. Tests will be shipped within 7-12 days.  Visit our website at bit.ly/HoCOVIDTesting for information on testing.

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* 1. First Name

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* 2. Last Name

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* 3. Home Address

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* 4. City/Town

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* 5. County

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* 6. Zip Code

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* 7. Apartment/Unit Number (if applicable)

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