Patient Lab Results

Ordering Physician:*
Patient Name*
First Last
Patient Date of Birth
MM slash DD slash YYYY
Sign consent form electronically ( attached PDF)*
Accepted file types: pdf, Max. file size: 512 MB.
Download the PDF here ›
Upload a photo of your ID*
Accepted file types: jpg, png, Max. file size: 512 MB.
Attach copy of designated person’s photo ID, e.g., driver’s license.
Email
Fax
Create a 4-digit Password