Request for COVID-19 Home Tests, Nurse COVID-19 Tests or Nurse Flu Tests
Employees- please remember any positive staff or student positive results should be reported to Health Services at (502) 485-3387.
Email *
Request for Nurse Binax tests for school testing (NURSES ONLY)
Request for Home Binax tests for students/families & JCPS employees
Are these COVID-19 home tests for an employee or student/household family?
LAST Name of student or employee requesting the tests
*
FIRST Name of student  or employee requesting the tests *
What is the name of the  employee's workplace or student's school? *
How many people are living in the household (census)?
*School Nurses pick 0.
*
I understand that if I  (or anyone in the household) has questions about COVID-19 they should contact their health care provider, school nurse or  can call Health Services at (502) 485-3387.   I also understand that people with underlying health conditions can have more risks from COVID-19 and if they test positive they should follow up with their health care provider to discuss medicines that can prevent serious illness.  If they do not have health insurance a list of clinics that can see patients at a lower cost based on income can be found by clicking the link: Community Health Centers - Louisville Kentucky

*
I understand that distribution of tests is based on availability from the KY Department of Public Health. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jefferson County Public Schools. Report Abuse