Sample Collection / other services Request
  • If you are NOT a Lab/ Hospital/ Dr, please enter 'SELF'
  • Enter the address of Lab / Hospital /Dr/ Self
  • You must enter SELF / Dr / Hospital / Lab Name
  • * services subject to availability
  • For multiple tests, please enter each test name followed by a comma. If this is not test request enter NONE
  • If you do not have Registration ID or not requesting a report, Enter NONE
  • If unknown/no clinical history or report delivery only please enter : NONE
  • / / :
    Please note: for instance, to enter 6 AM, you must enter it as : 06:00 AM and NOT as 6:00 AM
    If report delivery, just enter 00:00 AM
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