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Residents of the State of California Test Kit Request Form

Any resident of the State of California that would like to order a test kit, must have their health care provider sign a Test Request Form, which must be submitted to us before ordering a test kit.  

See instructions below on how to submit the completed form.

  1. Print the "Test Request Form", Click here to print the "Test Request Form".
  2. Have your health care provider sign the "Test Request Form".
  3. Email or fax the completed form to [email protected] or 406-730-8575.
  4. You will received an email or call from us.

If you have questions please call us at 1-877-238-1779