1. Introduction & Attestation

We are now ONLY fulfilling requests for antigen tests to support schools and early childhood education in an active outbreak or high-need and underserved communities (according to the Healthy Places Index).
  • Please use the form below to request your free At-Home Rapid COVID-19 Antigen Tests.
  • We will do our best to fulfill full orders but ultimately it will depend on the supply available.
  • To submit a request for PPE, please visit our PPE Request Form.
  • The DPH Antigen Test Distribution Program will end on February 28, 2025. After this date, no requests for antigen tests will be accepted or fulfilled.
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.

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

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* 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.

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