New account application form

Use the form below to open an account, once completed you will have access to great tests all performed in an accredited medical laboratory to use in your practice. There is no cost and no obligation. To be used by healthcare professionals only.

Once you submit your form your account will be opened; a confirmation email will be sent to you with the documents you need attached to help you get started. If at anytime you need help or better clarification of something, please contact our office and one of our customer service representatives will walk you through any process step by step.

 
 
Name *
Name
Clinic / Store Address *
Clinic / Store Address
http://
Phone *
Phone
Occasionally we will contact you with updates, additions or changes to our testing services. Your contact information is never shared and we will only contact you when necessary.