Rapid Test Device Request Form

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Rapid Test Device Request Form

Kansas HIV/AIDS Program

All Test requests are completed in the order in which they are received. Please allow up to a week for processing.

* Denotes required fields.






Test-Device-Quantity: How many boxes are you requesting?



 Additional Comments or Questions:

Questions: Contact Stephanie Green at (785) 296-5595 and the fax is (785) 296-5590.