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iFOB Test Kit Request Form

Please fill out the form below so we can mail you a new iFOB test kit (a test to check for colorectal cancer).

We will use the information you give us to make sure you are a patient at Hennepin Healthcare and to mail your kit to you. The information you share with us will be kept private and safe.

If you need a new iFOB test kit and do not have an address where we can mail it, please call or visit your clinic to get a new test kit.

First Name

Last Name

Mailing Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Contact & Verification

Date of Birth

Phone Number