ACCOUNT SETUP FORM

Prior to sending any samples, you need to complete the Account Setup Form below, or there may be a delay in processing.
ACCOUNT SETUP FORM

CLIENT INFORMATION


Client Bill
Dymo Printing
PharmD
This facility sends results to patients
Enable Auto Accession Generation

CONTACT INFORMATION


 
Critical Contact Details

Primary Physician Details



Special Requests


Specimen Pickup Information


UPSFEDEX
Pickup Time Requested:






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