At-Home (OTC) COVID-19 Test Order

This order form is for organizations authorized by the California Department of Public Health to order At-Home (Over-the-Counter, OTC) tests.

Note: This order form is intended for organizations outside of Los Angeles County.

Los Angeles County organizations can access at-home testing resources through LA County Department of Public Health. Please do not use this form; for more information, please visit LA County At-Home Testing Resources.

As of February 29, 2024, the CDPH At-Home Testing Program has come to an end for most organizations.

Local health departments (LHDs), skilled nursing facilities (SNFs), long-term care facilities (LTCFs) and elder care facilities can request at-home tests until February 28, 2025, or when testing resources are exhausted, to support populations who are high risk for severe disease.

If your organization is experiencing a COVID-19 outbreak, please contact your Local Department of Public Health. At-home tests requested through CDPH should be prioritized for priority populations (those who are uninsured, underinsured, have poor access to medical care, or are at high risk for severe disease).

Planning for Tests

Eligible entities should order a 2–3-month supply of tests. Please do not order more tests than you can safely store.
Tests must be stored indoors and temperature-controlled (Range 35.6-86°F)
Test brands vary based on availability. Requests for specific brands cannot be considered.
Boxes contain 2 tests. Instructions for the specific test will be included in each box. Please order 2 tests per person that you would like to distribute tests to (Example: If you want to distribute tests to 100 people, please order 200 tests).

Carestart includes 2 tests per box, 464 tests per case and 5,568 tests per pallet.

A case size is 12” L x 13” W x 11” H. and a pallet size is 4 ft x 4 ft x 6 ft.
Email confirmations are sent upon order submission and approval.
Please allow 1-3 weeks for delivery.

Please verify your order for accuracy before you submit.

By placing this order, you agree to the following

Tests in organizations will be distributed to people who are uninsured, have limited access to healthcare resources, or are at high risk for severe disease.*

Your organization CANNOT charge people for COVID-19 tests provided by the CDPH.

Your organization CANNOT bill patients' insurance for COVID-19 tests provided by the CDPH.

At-Home (OTC) Tests are self-tests. Tests must be self-performed and resulted by each individual (or their parent/guardian).

Organization Information

Organization Name

Type of Organization

My organization has previously received COVID-19 tests from CDPH.

Organization Point of Contact (Person Placing Order)

First Name

Last Name

Email Address

Phone Number

Verify Email Address

Delivery Point of Contact (Person Receiving the Shipment)

Provide direct phone number (cell phone is best) to coordinate delivery of testing materials
Be available at shipping address to receive during working hours

Delivery POC Same as Org POC

Delivery POC First Name

Delivery POC Last Name

Delivery POC Email

Delivery POC Phone

Must be the person's direct phone number (cell phone is best, no extensions)

Secondary Delivery Contact Name

Secondary Delivery Phone

Must be the person's direct phone number (cell phone is best, no extensions)

Delivery Information

Important: Please review and verify your address to avoid delays.

No P.O. Boxes; must be a street address
Must be in California
Delivery Point of Contact must be at the address to receive the shipment

Please consolidate orders when possible. Ship to a central location, like a headquarters or district office. If tests must be shipped to more than one location, submit a separate order for each address.

Attention

Street

Building/Suite

City

County

Zip Code

Additional Delivery Instructions

Receiving Hours

Test Information

Please order a 2-3 month supply for testing eligible participants at all locations for your organization.
Eligible participants are those that are uninsured, underinsured, or have poor access to medical care, or those at high risk of severe illness (immunocompromised, those over >65 years).
Please note: Routine COVID-19 testing is no longer required in non-high-risk and/or acute health care and long-term care settings.
2 tests may be in one box. Please order the total number of tests needed for each individual to receive two tests. E.g., for 500 people request 1000 tests.

What is the total population that your organization serves?

Total At-Home Tests Requested

Additional Comments, Explanations, or Requests:

Please verify your order for accuracy before you submit.

Once approved, orders cannot be changed or corrected

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