Testing Order Form

Order Your Own Testing

No Appointment Cost. Free Shipping. Get Answers.
Pros of buying testing on its own like this:
- No Appointment Costs
- Choosing the test you already know you want
- Getting access to our treatment dispensary so you can buy what supplements you would like
Cons of buying testing on its own like this:
- No appointment with the doctor
- Costs are not the discounted prices our patients get
- No specially formulated treatment plan for your results
By ordering test through this form, you acknowledge that you are not a patient of our office and that you will get no appointment or subsequent treatment plan.

You will get:
- Your test with detailed instructions on how to complete it
- Customer service to answer collection questions
- Access to our treatment dispensary and a general treatment plan
If you would like to have an appointment after recieving your results for help interpreting the results, please scheudle an 'Ask Dr. Kilcup' appointmemt. If you would like a personalized treatment plan, you must fill out the New Patient history form.

My Products

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Patient Information

Information of the person doing the test collection
Full Name*

First NameLast Name
Date of Birth:*

MonthDayYear
Date
E-mail*
example@example.com
Contact Number*
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
TESTING NOT AVAILABLE IN NEW YORK DUE TO NEW YORK LAW

We appologize for the inconvenience.
Is shipping address same as billing address?*

YesNo
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Return Policy:*

By proceeding you are agreeing to our return policy, which is: tests can only be returned within 30 days of purchase. A 10% restocking fee will be taken out of any refund. Refunds are not available after the lab has received a sample.
Signing here agrees to the above and finalizes the order:

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