Book a Mobile Blood Draw & Lab Delivery Appointment!

Book a Mobile Blood Draw & Lab Delivery Appointment!

Home or Workplace draw for you, your family, or your business
Fax Lab Orders to 888-466-4622.
This blood draw is for
Contact Name

First NameLast Name
Patient's Date of Birth

MonthDayYear
Date
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What date and time will work best for you?
Any other specific date and time, if the above selection is not suitable.

MonthDayYear
Date
Hour MinutesAM/PM Option
Please provide info on specific times and dates, special handling and mobile concerns.
Billing
Service Provided
Payment for services provided by Prolab Solutions are collected prior to the appointment.
How many patients ?
Lab Order Type
How Often?
Special Requirement
ADD Blood Draw Requistion Form

Upload File: IMAGE or DOCX or PDF
Cancelof
ADD front and back of insurance card

Upload File: IMAGE or DOCX or PDF
Cancelof
Next Steps - You will receive a phone call once we have this information we can provide availabilty details and final pricing. A Payment Invoice will be sent to the email provided. Payment for the fees must be received before the appointment date for us to proceed with the scheduled blood draw. If you cancel less than 24 hours before visit, you will have a $25 charge next visit.
Signature
Should be Empty: