Nassau County

COVID-19 Self-Test Kit Request

Organizations/Agencies

Please read before submitting a request

You will receive an email, in 1-3 business days, with instructions on how to pickup your supplies.
Please complete all fields below.

The expiration date for the iHealth Rapid Tests have been extended. Refer to this link: https://www.fda.gov/media/158007/download for the new date.

Request

First Name*

Last Name*

Agency/Organization Name*

Address*

City*

State*

Zip Code*

Email*

Verify Email*

Primary Contact Cell#*

Secondary Contact Cell#*

Number of Clients/Residents/Patients*

Number of Employees*

Enter quantity and then click the 'Submit' button below

COVID-19 Self-Test Kits (2 tests in each kit) - Number of kits needed*

Additional Comments

Review the above information, and if correct, click the SUBMIT button.