SinclairMethod.org
1455 NW Leary Way Suite 469
Seattle, WA 98107
Tel: 1-888-323-0575
Email: info@sinclairmethod.org
Please fax results to: (206) 707-8299
Name of Laboratory
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Name of Laboratory
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LabCorp
Quest Diagnostics
Laboratory FAX
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Patient's Name
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First Name
Middle Initial
Last Name
Patient's Name
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Date of Birth
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Patient's Phone
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Sex:
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Male
Female
LAB ORDERS:
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Hepatic Panel Function (7)
Gamma Glutamyltransferase (GGT)
Complete Blood Count (CBC) With Differential
Comprehensive Metabolic Panel
B Vitamins
Vitamin D, 25-Hydroxy
Serum HCG
Urine Toxicology
Diagnostic Code (s)
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F10.10
Z79.899
Instructions to Client:
Signature
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Peter T. Swanljung, M.D.
NPI: 1770620478
Date
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Month
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Day
Year
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