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Specimen Kit and Supplies Request Form

  1. All orders will be shipped within 3 business days of submission.

  2. Health Submission Forms
    1. Amount

    2. Amount

    3. Amount

    4. Amount

    5. Ambient Multi-tube Container with Mailing Box 

    6. Valid for ALL Serology and Viral Specimens

    7. Swabs and VTM packaged together

    8. Swabs and VTM packaged together


    9. (Valid for COVID only)

    10. (Swabs, empty tubes & specimen bags)

    11. (For Viral specimen collection)

    12. (VTM)

    13. (Gold-top)

    14. (Pour off Tube)

    15. (Venous Blood Metals)

    16. (Capillary Blood Metals)

    17. (Capillary Blood Lead collection only – not NBS)

    18. (with Sputum Collection tube)

    19. Multi-tube Container with Mailing Box

    20. Please Specify

    21. Type Needed

      **UPDATE: BD Veritor Test Kits Require an Analyzer. KDHE will no longer provides analyzers. Analyzers are available for purchase through a variety of vendors. **

    22. **UPDATE: BD Veritor Test Kits Require an Analyzer. KDHE will no longer provides analyzers. Analyzers are available for purchase through a variety of vendors.**

    23. Leave This Blank:

    24. This field is not part of the form submission.