Return To Shopping Cart
NAME / BIRTH DATE:
EMAIL / ADDRESS / PHONE:
Male
Female
By signing below, I acknowledge: 1) No test other than the specific test(s) ordered shall be performed on the biological sample. 2) The information in the patient information is accurate, and I give Infinite Labs consent to release results to the email address listed in the patient information section and to Danbar for Life when applicable.
PATIENT SIGNATURE:
Erase Signature