Inforouge

1

Did your doctor ask you to get a blood test or other medical test?

Yes

No

2

When do you need a blood test done?

As soon as possible

Within 2 weeks

Within 30 days

Within 2 or 3 months

3

Do you have private medical insurance?InfoRouge is a private clinic that does not accept Medicare, rather our fees are paid by you or by your private insurance. Starting at $149, results are fast and our nurses are happy to help.

Yes

No

4

Medical Requisition FormPlease provide all the pages of your medical requisition from your doctor.

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Select files to upload

Max. file size: 10.6MB

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5

When do prefer an appointment?

I prefer the morning

I prefer the afternoon

I prefer the early evening

I have a flexible schedule

6

Select an appointment or click "NEXT" to proceedAll appointments will be confirmed by our staff

7

Name* This field is required.

First Name

Last Name

8

Email* This field is required.

example@example.com

9

Mobile Phone Number* This field is required.Our nurse will call you to discuss your situation and provide further assistance. We take privacy seriously and do not share your information.

Please enter a valid phone number.