Form can be submitted on next page.

Please only complete the yellow highlighted sections on this sample form (disregard the items that are crossed out). Please make sure you complete your insurance information, include the ICD-10 code (U07.1), and select the SARS-CoV-2 (COVID-19) screening test.

On the included cup, write your full name and date of birth using a permanent marker.

1. Wash hands for at least 20 seconds with hot, soapy water. Make sure you are taking your sample in a clean and disinfected area.

2. Open the lid of the container and grab some tissues.

3. Hold a tissue over your nose and mouth and cough a few times; this helps produce saliva.

4. Spit into your labeled sample cup. Spitting 2-3 times into the container should provide enough material for testing - go slowly if you need to.  See image of blue liquid for an example of the amount needed.

5. Rinse and Seal the Cup: Rinse any excess spit and let dry, then close the lid slowly and firmly. Leaked samples cannot be tested!

1. Place your sample cup in the included lab bag.

2. Fold up your completed requisition form and place it in the front pocket of the lab bag or if no pocket, just place it inside the box.

3. Seal your lab bag tightly with tape or with the adhesive strip (if included).

4. Place the lab bag back inside the box and seal the box tightly.

5. Find your nearest FedEx Drop Box, or schedule a pickup by calling 1.800.463.3339

FedEx Drop Box: https://www.fedex.com/en-us/shipping/dropbox.html
FexEx schedule a pickup: https://www.fedex.com/en-us/shipping/schedule-manage-pickups/how-to.html

Your test kit includes prepaid overnight shipping back to the lab for testing.