Order Your ZRT Hormone Testing Kit

Order Your ZRT Hormone Testing Kit

Please complete the following HIPAA-secure form to order your ZRT Hormone Testing Kit.
Patient Information
Patient Name*

First NameMiddle NameLast Name
Patient Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Patient Shipping Address If Different than Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Patient Phone Number*
Format: (000) 000-0000.
Patient Email*
example@example.com
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Patient Date of Birth*

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Date
Order Your ZRT Kit

If you know which test kit you'd like to take, we will place the order on your behalf with ZRT Laboratory as a registered provider. ZRT will ship the kit directly to you. Follow the instructions enclosed in your kit and mail it back to ZRT. We will contact you for payment. Your lab results will be shared with Valor and a pharmacist will contact you with recommendations for bioidentical hormone replacement therapy, as appropriate.
Which test kit would you like to order?*
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Female/Male Saliva Profile I
This kit tests estradiol (E2), progesterone (Pg), testosterone (T), DHEAS (DS), and cortisol (C). The cortisol testing will be 1 sample in the morning.

$130.00



Female/Male Saliva Profile III
In addition to testing the same hormones as Profile I, this kit also includes 3 additional cortisol samples collected from noon, evening, and night. If you are concerned about your stress levels, this kit would be more comprehensive to track your cortisol hormone through the day.

$230.00



I am not sure. I would like a free consultation to help me pick the best kit for me.
Unsure which kit is right for you? We're happy to help. A pharmacist will contact you for a consultation before proceeding.

$ Free



Total

$0.00
Prescriber Information
Are you currently seeing an Integrative, Functional, Transformational, or Primary Care Medicine doctor or provider?*
Prescriber's Name

First NameLast NameSuffix
Prescriber's Phone Number
Format: (000) 000-0000.
Prescriber's Fax Number
Format: (000) 000-0000.
Prescriber's Email
example@example.com
Office Email
example@example.com
Business Name
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
License #
NPI #
DEA #
Any additional information you would like us to know?
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Thank you for completing the trasnfer prescription form. You may electronically submit the order to Valor Compounding Pharmacy by clicking "Submit" below.

A Patient Services Representative will contact you within 24 hours.
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