DIRECT-TO-PATIENT ORDER FORM

By using this form your order will be shipped directly to your patient's address

To place your Breath Test Collection Kit order on behalf of your patient, please complete all the information fields below. Online ordering through this web-portal is available to customers in the United States only. For customers outside of these territories please contact CDI’s Customer Service Department at 1-888-258-5966 or via email at CustomerService@CommDx.com.