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1.  Complete the form below to request prescription from Dr. Husty for the screening.
2.  Wait 2 business days for the prescription to be sent to the facility you choose,  then call to make your appointment.
3.  You will receive notification of your test results from Dr. Husty's office.
4.  Follow-up with your physician if needed.

Request Form

Please type the name of the agency that you are an employee/ relative or friend of.

Agency Affiliation*
First Name*
Last Name*
Street Address*
City State & Zipcode*
Personal Phone Number*
E-mail Address*
To prevent spam, please tell us:
What is 0 + 5 ?


$ 110.00 at Central Florida Regional
$ 100.00 all Orlando Health locations
$   50.00 South Seminole Hospital, discount*
* Discount for any employee of any Fire Department Agency within Seminole County and any Longwood Police Department employee.

Call to Schedule

CFR Sanford - 888-894-2106

Orlando Health - 321-841-5274


Learn More - Central FL Regional

Learn more - Orlando Health