COVID-19 Home Test Kit Request Form
DHHS has rapid antigen home test kits ready for distribution while supplies last

Some considerations about home test kits:
  • These tests have expiration dates that range from 2-12 months. DO NOT DISCARD WITHOUT CHECKING FOR EXPIRATION DATE EXTENSION. Check for expiration extension here:
https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/home-otc-covid-19-diagnostic-tests#list
  • Test results are not shared with public health and are for client information only. Test administration is not observed or proctored, and results do not serve official reporting purposes.
  • This test does not replace official testing at a healthcare provider office.  


Please complete this form if you are interested in receiving test kits to distribute within your community.

If you have any questions please contact:
Carla Arancibia
Self Test and K-12 Coordinator
carancibia@utah.gov
385-258-6741
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Email *
Which of the following best describes your organization?
*
Name of Organization *
Contact Person Name *
Contact Person Phone Number *
Do you want to pick up or have the tests shipped?
Warehouse Address and Hours
1865 South 4490 West Salt Lake City, Utah 84104. Hours: 7:00am-3:00pm Mon-Fri Excluding Holidays
*
If shipping, is your address:
Full Shipping Address including City and ZIP- cannot ship to PO Box! (If picking up, enter "Will Call"). *
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