KY FREE TESTING PROGRAM (Including K-12)

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KY FREE TESTING PROGRAM (Including K-12) - Clinic Request Form

Hello and thanks for being a site partner for a Community Vaccine Clinic with Wild Health, Team KY, and UK!

Here are all the details and questions that you need to know to host a successful site.

Please provide them below. If you’re not sure about one of them, then go ahead and skip that section, and we’ll help you clarify and decide on the phone.

FAQ’S:

How much does this cost?
Free for everything, no insurance is being billed. It is all being paid for by the Commonwealth of Kentucky or in partnership with the University of Kentucky. As a partner site you would not be charged a facility fee, on on-site fee, a ‘convenience fee’. The TOTAL cost to any and all parties involved is $0.

How long does getting tested take?
We can test anywhere between 30-100 people within the span of 10 minutes. This all depends on the amount of team members we send. The process is quick and efficient for the patient so that your community is not waiting.

How long does getting results take?
Rapid results take 15 minutes, and RT-PCR results take <24 hours to result.

What type of tests do you offer?
We offer both BinaxNOW Rapid Antigen Tests and RT-PCR Tests. We can offer both or only one at any clinic.

Can I see my employee's results?
A waiver can be added to your scheduling portal in order to allow the employer access to results.

Name of the organization? *

Client contact name? *

Client contact phone? *

Client contact email? *

Address of location (street address, city, state, zip) *

What time zone is the site located in? *

EST

CST

PST

How many people do you expect to need testing? *

What type of testing are you requesting?

Rapid Antigen (15 minute results)

RT-PCR (<24 hour results)

Both (recommended)

Clear selection

What type of clinic would you like?

One-off

Surveillance (this means repeating - so weekly, biweekly, monthly etc)

Outbreak (<24 hour response time needed)

Clear selection

Please state the time frame you would be able to hold this clinic within (ex: 9am-5pm).

What date would you like to test on? *

YYYY

How much of your facility is vaccinate?

<20%

20-40%

40-60%

60-80%

>80%

Clear selection

Submit

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