1. Select Tests
  2. Shopping Cart Tests in Cart: {{currentCart.length}}
  3. Select Draw Center Select Draw Center
  4. Patient Info Patient Info
  5. Payment Payment

Order Information

The Blood Draw Center You Chose
Laboratory:{{ psc.Lab }}
Address:{{ psc.Address }}
City/State:{{ psc.City }}, {{ psc.State }}
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The Blood Tests You Chose
{{ test.Name }} {{ test.Price | currency:$ }}
Blood Draw Fee{{ drawFee | currency:$ }}
Discount{{ discountValue() * -1 | currency:$ }}
{{ cartTotal() | currency:$ }}

Patient Information

First Name: Gender:
Last Name: Date of Birth: 01/31/1999
Address: Phone #: 555-555-5555
Zip Code: State:
Email:
Choose a Password:
Email:

The information collected above is used to generate a requisition form that you will print after you place your order. You will bring this paperwork to the location you have selected and have your blood drawn. This personal information is kept confidential and is not shared with anyone.

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