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

Phone type    
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.

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