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First Name Middle Name Last Name Street Address Address Line 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Maine, Maryland, New Jersey, New York, and Rhode Island do not allow direct to consumer testing. If you live in one of these states, we apologize for the inconvenience.

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Clinic Name Clinic Street Address Clinic Address Line 2 Clinic City Clinic State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Maine, Maryland, New Jersey, New York, and Rhode Island do not allow direct to consumer testing. If you live in one of these states, we apologize for the inconvenience.

Clinic Zip Code