Patient Pre-Registration

Register
Demographics
***Please ensure that the patient name and date of birth are identical to the information appearing on the patient's government issued ID***

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Please enter your driver's license inormation OR your primary insurance number for identification purposes.
Please upload an image of your id and enter your drivers license number [If appropriate input is provided].
Specimen Information
Payment Method
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Primary Insurance
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Please take a photo of the front of your insurance card and upload.
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Please take a photo of the back of your insurance card and upload.
Patient Signature (Parent/Guardian signature for patients under 18)
*By clicking submit the patient gives authorization for test results and associated protected health information (PHI) to be sent via digital delivery methods including SMS text and email.