get an order form

To make it easier for your healthcare provider to order Cologuard, fill out as much of the information as you can below.

Once you're done, we'll use the information you fill out to instantly generate a printable, customized PDF order form that you can bring to the office. Then, your healthcare provider can complete it and send it back to us for processing.

Remember! Only your healthcare provider can determine if Cologuard is right for you.

 

Your Information

   

Optional: Are you of Hispanic or Latino origin or descent?
Optional: Please mark one or more to indicate your race:




Your Shipping Address


Your Billing Address


Your Insurance/Billing Information


Do You want Exact Sciences to bill your insurance?

 



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.

The New 50 generation is about having options.”

Have questions about
insurance and billing?

Learn more

JERRY KELLY AND COLOGUARD ARE TEAMING UP

Learn more