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.