Phlebotomist Questionnaire

Phlebotomist Questionnaire

Please answer the questions below in order to be added to our draw site locator.
Company Name*
Contact Name *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a mobile phlebotomist?

YesNo
If Yes, what zip codes do you serve?
Are appointments necessary?

YesNo
Do blood draws need to be completed by a certain time?

YesNo
Are you able to draw for our test kits?

YesNo
Are you able to ship the kits for the patients?

YesNo
What are your fees?
Thank you in for answering these questions, we will try our hardest to make these changes in the next 7 business days.
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