Appointment Request Form

Test Option*

Type of Appointment*

*NOTE: If you require sibling testing you must call to schedule due to the complicated nature of testing.

Special Instructions

Test Participant 1

NOTE ON PREFERRED DAY/TIME: If you selected the standard option, testing hours are typically Monday through Friday, 10am to 4pm. If you selected the expedited option, testing hours are typically Monday through Friday, 8am to 6pm. Some Saturday appointments and mobile services are available, depending on your location. If you have questions about testing times, please contact us at 866.944.9546.

Name*

DOB*

Zip Code*

Relationship*

Preferred Day/Time

Test Participant 2

NOTE ON PREFERRED DAY/TIME: If you selected the standard option, testing hours are typically Monday through Friday, 10am to 4pm. If you selected the expedited option, testing hours are typically Monday through Friday, 8am to 6pm. Some Saturday appointments and mobile services are available, depending on your location. If you have questions about testing times, please contact us at 866.944.9546.

Name

DOB*

Zip Code*

Relationship*

Preferred Day/Time

Test Participant 3

NOTE ON PREFERRED DAY/TIME: If you selected the standard option, testing hours are typically Monday through Friday, 10am to 4pm. If you selected the expedited option, testing hours are typically Monday through Friday, 8am to 6pm. Some Saturday appointments and mobile services are available, depending on your location. If you have questions about testing times, please contact us at 866.944.9546.

Name

DOB*

Zip Code*

Relationship*

Preferred Day/Time

Test Participant 4

NOTE ON PREFERRED DAY/TIME: If you selected the standard option, testing hours are typically Monday through Friday, 10am to 4pm. If you selected the expedited option, testing hours are typically Monday through Friday, 8am to 6pm. Some Saturday appointments and mobile services are available, depending on your location. If you have questions about testing times, please contact us at 866.944.9546.

Name

DOB*

Zip Code*

Relationship*

Preferred Day/Time

Test Participant 5

NOTE ON PREFERRED DAY/TIME: If you selected the standard option, testing hours are typically Monday through Friday, 10am to 4pm. If you selected the expedited option, testing hours are typically Monday through Friday, 8am to 6pm. Some Saturday appointments and mobile services are available, depending on your location. If you have questions about testing times, please contact us at 866.944.9546.

Name

DOB*

Zip Code*

Relationship*

Preferred Day/Time

Test Participant 6

NOTE ON PREFERRED DAY/TIME: If you selected the standard option, testing hours are typically Monday through Friday, 10am to 4pm. If you selected the expedited option, testing hours are typically Monday through Friday, 8am to 6pm. Some Saturday appointments and mobile services are available, depending on your location. If you have questions about testing times, please contact us at 866.944.9546.

Name

DOB*

Zip Code*

Relationship*

Preferred Day/Time

Contact Information

We typically provide appointment details within a few hours. All requests received after 6pm EST Monday - Thursday will be handled the following morning. All requests received Friday after 6pm EST, Saturday or Sunday will be handled Monday morning.

Preferred Contact Method*

Primary Contact Name*

Phone*

Email*

Secondary Contact Name

Phone

Email

Comments

This field is for validation purposes and should be left unchanged.

CALL866.944.9546

TO SCHEDULE AN APPOINTMENT

PLEASE CALL 866.944.9546 or ORDER ONLINE