PHLEBOTOMY BY KAR LLC -

Fax Number: Birth:

PATIENTS INFORMATION:

New patients all information will be reviewed and you will be contacted via email or phone for confirmation. Unfortunately at this time we do not accept insurance for service payments.

Name:

First

Last

Date of Birth:

Phone Number:

Email:

SERVICES:

BLOOD DRAW - $55.00
URINE ANALYSIS - $55.00
STOOL COLLECTION - $55.00

OUR SERVICES: (Pricing is subject to change based on location.) ----------------------------------------------------------------------------------------------------------------------------------------------------------------- At Phlebotomy By KAR, LLC, we provide professional mobile specimen collection services with compassion, precision, and convenience. Our experienced, certified phlebotomists travel directly to your home, workplace, physician's office, healthcare facility, or research location, eliminating the need for unnecessary travel while ensuring every specimen is collected safely and accurately. We are committed to delivering exceptional patient care while maintaining the highest standards of professionalism, confidentiality, and specimen integrity.

PHYSICIAN INFORMATION:

Enter your physician information here.

Name:

First

Last

Practice Name:

Phone Number:

Fax Number:

APPOINTMENT ADDRESS:

PREFERED APPOINTMENT:

EX: MORNING, AFTERNOON, EVENING

Total

$0.00

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