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, you'll be able to print a 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

   


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.

Have questions about
insurance and billing?

Read the FAQs