Get an Order Form to Give to Your Doctor

Fill out the form below to make it easier for your healthcare provider to order Cologuard. Once you're done, you'll be able to save or print a customized PDF order form you can send or bring to your healthcare provider so he or she can complete it, sign it, and send it back to us for processing.

Please note that only your healthcare provider can determine if Cologuard is right for you and complete the ordering process. Cologuard is approved for use by men and women, 50 years of age and older, who are at average risk for colorectal cancer.

Cologuard is not for everyone. It is not a replacement for diagnostic or surveillance colonoscopy in high-risk individuals. You may be a high-risk individual if:

  • You have a personal history of colon cancer, polyps, or other related cancers
  • You have a family history of colon cancer
  • You have had a positive result for another screening method in the last six months

For complete information on Cologuard, please click here.

Your Information

   

Your Shipping Address

Your Billing Address

Your Insurance/Billing Information

By clicking the button below, you are generating a PDF order form to be completed by your healthcare provider. You are not ordering the test. Only a licensed healthcare provider can order Cologuard.

 

Trying to view or edit your PDF after generating it? Please download Adobe Reader (it’s free) for best results.

Next Section: Connect to a Physician Now »