Order Form for HIV Testing Kits and Supplies - Florida Department of Health in Miami-Dade County

Tips for Ordering Rapid Test Kits
Minimum of 10 days from when the order form is received (an overnight delivery will not be used, except controls if applicable).

Requester Information

Requester Name(Required)

Email(Required)

Phone Number(Required)

Agency Name(Required)

Agency Address(Required)

Street Address Address Line 2 City State ZIP Code

Site Number(s)(Required)

Testing Kit Order Form Information

Select Items to Order(Required)

OraSure Boxes(Required)

Each box contains 50 test kits

Linkage to Care Forms(Required)

OraQuick Boxes(Required)

Each Box contains 100 test kits

OraQuick Control(Required)

Each set of controls can be used about 25 times, if used correctly. OraQuick control expired 8 weeks after opening.

SureCheck(Required)

Each box contains 25 test kits

SureCheck Control(Required)

Each set of controls can be used about 25 times, if used correctly.

INSTI(Required)

Each box contains 50 test kits

INSTI Control(Required)

Each set of controls can be used about 7 times, if used correctly.

Condom Order Form Information

Select Items to Order(Required)

Terms of Use

By placing this order, I agree to each of the following:

All items ordered through this program must be provided FREE of charge.
All of these items will be distributed solely within Miami-Dade County.
The staff, volunteers and other agents of my organization may not knowingly furnish these items for re-distribution outside of Miami-Dade County.
I will cooperate with staff from the Florida Department of Health in Miami-Dade County Condom Program in evaluating this program.

Select(Required)

I Agree

I Disagree

Other Request

Indicate your order on the form below. The quantity specified should be the number of cases you would like for each item.

Male condoms
Female condoms
Other latex barriers
Lubricants

NOTICE: We make no assurances that we have the itemized products in stock. We reserve the right to:

Deny any order or in partl
Adjust the quantity of orders; and
Substitute items.

Please allow approximately 6-8 weeks for this order to be filled.

ONE Legends (1,000 per case)