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iFOB Test Kit Request Form

Please fill in the form below so we can mail you a new iFOB test kit (colorectal cancer screening test kit).

The information you share will be used to confirm you are a patient at Hennepin Healthcare and for communicating about and mailing your iFOB kit. The information you share with us will be kept private and secure.

If you need a new iFOB test kit and do not have a mailing address, please call or stop into your neighborhood clinic to pick up 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