Free COVID-19 Home Test Kits

2. 

4. Free COVID-19 Home Testing Kits

   Each kit contains two (2) tests and are available to the residents of the 17th Legislative District while supplies last. There is no charge but please note that, as supply is greatly limited, only one kit per household will be allowed.
   
   *Note* At this time, tests must be picked up at our office, 130 W. Jericho Turnpike in Huntington Station. Please call (631) 854-4433 with any questions.

6. First Name:*
7. Last Name:*
9. Address:*
11. City:*
12. State:*
13. Zip / Postal Code:*
15. Telephone: *
16. Email Address:
18. Do you have symptoms of COVID-19 or are you feeling unwell?

    This question is asked for the health and safety of our staff. (You will still be able to receive a COVID-19 home testing kit.)

    1. Yes
    2. No
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field