Potassium Iodide Request Form

Your KI tablets in addition to instructions will be mailed directly to you address at no charge.

Please note that KI tablets will ONLY be mailed to addresses WITHIN the 10 mile EPZ.

Your IP address of:

has been logged in our system and will be associated with this request.

 

First Name: Last Name:

Street Address: , , New York

Number of pills needed 130mg: (1 pill for each occupant over the age of 12)

Number of pills needed 65mg: (1 pill for each occupant under the age of 12)

Contact Number:

Email Address: