REQUEST FORM FOR TAKE-HOME COVID-19 Test Kit
Courtesy of TPCHD (in collaboration with Rankos Pharmacy)
Test recipient(s) must be 16 years of age. Is/are the person/people to be tested 16+ years old?
Do you live or work in Pierce County?
Please enter a valid phone number.
Number of Kits Requested
Current Maximum of 2 KITS PER HOUSEHOLD PER WEEK
Requested Curbside Pickup Date & Time. DO NOT ENTER THE PHARMACY. Call us when you are parked outside ***NOTE: WE are flexible & will work with your needs....we will do all we can to assist
Should be Empty: