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Rapid Test Kit Orders for Doctors’ Offices

Rapid Test Kit Orders for Doctors’ Offices

This form is for medical clinics and physician practices only.

This form allows doctors’ offices to order take-home rapid test kits for distribution to patients. Doctors Manitoba will share your orders with the province of Manitoba. The province’s goal is for doctors’ offices to distribute these rapid test kits to patients attending the clinic for appointments, for their future at-home use, so they are prepared should they develop symptoms.

Clinics should order a quantity of test kits to last about 2 – 4 weeks. See the note below to help estimate the right quantity for your clinic.

Test kits should be delivered within 1 – 2 weeks of order.

Clinic Name *

Requestor Name *

Ship to Address *

Cannot be shipped to a PO Box

City *

Province *

Postal Code *

Phone Number *

Email *

RHA *

Quantity of Test Kits Requested:

Note: to determine how many test kits to order, estimate how many patients over the next 2 – 4 weeks will attend your clinic in person and accept take-home rapid test kits to have on hand should symptoms develop. For example, if your clinic’s physician group sees 50 patients in person on a typical day and you believe half will take home free rapid test kits, order 250 to 500 kits (25/day X 2 weeks or 4 weeks).

Number of Test Kits Ordered *

Special Delivery Instructions/Helpful Information

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