Phlebotomist Questionnaire

Phlebotomist Questionnaire

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

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you a mobile phlebotomist?

Yes No
If Yes, what zip codes do you serve?
Are appointments necessary?

Yes No
Do blood draws need to be completed by a certain time?

Yes No
Are you able to draw for our test kits?

Yes No
Are you able to ship the kits for the patients?

Yes No
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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