COVID-19 Binax At-Home Testing Request Form (Shipments for Organizations)
Thank you for requesting your Binax at-Home test kit through the Colorado Department of Public Health and Environment. We appreciate you taking the steps to slow the spread of COVID-19 to protect yourself and your community.

Currently, we are still accepting orders for the Binax at-Home test kits. However, due to low inventory, we will not be able to fulfill any requests at this time. We will notify you when shipments resume.

If you need to request additional testing supplies, please submit a request for Bulk Binax. This program is different from Binax at-Home --  tests come in kits of 40 per box and must be administered by a trained professional at a Clinical Laboratory Improvement Amendments (CLIA)-waived facility. A CLIA ID number can be obtained by completing this application and submitting it to CDPHE.

If you have any questions please reach out to cdphe_covidtesting@state.co.us. Thank you.
Sign in to Google to save your progress. Learn more
Email *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of State.co.us Executive Branch. Report Abuse