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Mobile & on-site collection services

This scheduling form is for on-site (your location) or mobile collection services only. If you plan to visit LABS TO GO clinic, do not fill out this form — no appointment is needed for in-clinic services, as they are available on a walk-in basis only.

If you have questions, need clarifications, or if you are a company interested in setting up a business account with us, feel free to reach out through our Contact form.

We look forward to serving you!

Customer Information

Are you a returning customer? *

Full Name *

Company / Organization (if applicable)

Phone Number *

Fax Number (optional)

Email Address *

Your Address

Street Address *

City *

State *

ZIP Code *

On-Site/Mobile Service Information

Note: Mobile Fee is applied for each visit, in addition to the collection or testing fees.

Type of Service(s) *

Number of Patients *

Collection or Testing Site Address

Address *

Are all patients at the same location? *

1st Preferred Date & Time *

Date

Time

2nd Preferred Date & Time *

Date

Time

Other Information

Additional Notes / Questions

How Did You Hear About Us? (Optional)

I understand that this form is for on-site/mobile collection services only. I agree that a mobile fee will be added in addition to collection or testing fees. *

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