1. Organization Information

Please use the form below to request your At-Home Rapid COVID-19 Antigen Tests.

These tests are intended for communities hardest hit by COVID-19 that cannot otherwise access resources. The tests are not intended to be used by your organization's staff.
 
Please submit requests for antigen tests on an as-needed basis but no more than once a week per address. At this point in time, you can request up to a 3-month supply. We will do our best to accommodate requests, dependent on our available inventory.
 
You will be receiving a confirmation email from us when your tests ship.

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* 1. Please enter your organization name.

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* 2. Non-profit or For-profit Organization?

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* 5. Enter your organization's street address for delivery. Please note the address must be located in Los Angeles County.
Example: 200 N Spring St

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* 6. Enter your organization's unit or suite number.
Enter "N/A" if not applicable.

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* 7. Enter your organization's City.

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* 8. Enter your organization's 5 digit zip code.

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