ACCOUNT SET UP FORM

Prior to sending any samples, you need to complete the Account Set Up Form below, or there may be a delay in processing.
ACCOUNT SETUP FORM

CLIENT INFORMATION


CONTACT INFORMATION



PHYSICIAN SIGNATURE:

SHIPPING INFORMATION



Specimen Pickup Information


 
COURIERFEDEX
Pickup Time Requested:

Pre-made Kits:

Blood
X

Toxicology
X

DNA
X

Pathology
X