Request for COVID-19 Home Tests

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Employees- please remember any positive staff or student positive results should be reported to Health Services at (502) 485-3387.

Email *

Are these COVID-19 home tests for an employee or student? *

Employee

Student

LAST Name of student or employee receiving the tests
*

FIRST Name of student or employee receiving the tests *

What is the name of the employee's workplace or student's school? *

How many people are living in the household? *

Best number to reach you if needed *

I understand that if I (or anyone in the household) has questions about COVID-19 they should contact their health care provider, school nurse or can call Health Services at (502) 485-3387. I also understand that people with underlying health conditions can have more risks from COVID-19 and if they test positive they should follow up with their health care provider to discuss medicines that can prevent serious illness. If they do not have health insurance a list of clinics that can see patients at a lower cost based on income can be found by clicking the link: Community Health Centers - Louisville Kentucky

Yes

No ** Please Contact Health Services at (502) 485-3387**

I understand that distribution of tests is based on availability from the KY Department of Public Health. *

Yes

Send me a copy of my responses.

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