COVID-19 Information Request

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Thank you for your interest in our COVID-19 panel. Please fill out the information below and someone will be in touch.

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Organization Name *

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Contact Name *

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Type of Organization *

Hospital

Lab

Clinic

Other:

Address *

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Phone Number *

Your answer

Volume per week

Your answer

Collection Kits

I will need collection kits

I already have collection kits

Clear selection

Sample preservation solution brand (transport medium)?

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