*Required
Insurance Provider*
Some private insurances help cover costs. We work on your behalf to find out. For cash-pay patients, enter "N/A"
We legally cannot take-on care for the listed insurance. Please adjust if a mistake was made. For cash-pay patients, simply put “N/A”
Contact Phone*
Please enter a phone number for the primary contact on the order.
Please enter a ten digit phone number
Name & Date Of Birth*
Please enter the name and DOB of all individuals who will be completing the test kit(s). If the individual is over 18, please enter a unique phone number for that individual.
