top of page
Become A Boardmember
Donate Now
Patient Portal
Home
Telehealth
Services
Medical Services
Behavioral Health
Dental Care
Vision Care
Pharmacy
HIV Care + PrEP
Health + Nutrition
Patient Forms
Patient Portal
Sliding Fees
Insurance Enrollment
News
Recognition
Press Room
Patient of the week
Careers
Our Team
Our Providers
Our Supporters
Contact Us
Locations
More
Use tab to navigate through the menu items.
COVID-19
Home kit registration
Patient Information
First Name
Last Name
Date of Birth
Phone
Email
Preferred Language
Click to Review Options
Is Individual Vaccinated?
Click to Review Options
Specify Language
No. of Test Kits
If other, please specify
Best Time to Contact
Click to Review Options
Site
Click to Review Options
Employee Name
Click to Review Options
City of Outreach
Block Code
Staff Member Name
Submit
bottom of page
