Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of Birth *Phone *Email *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCheckboxes *Annual Check-Up Panel $123CBC $47UA DIPSTICK $47Fatigue Panel (CBC, CMP, A1C, Ferritin, TSH) $153Basic STD Panel $161Weight Management Hormone Panel (CBC, CMP, Estradiol, Cortisol, DHEA, Progesterone, TSH, Testosterone) $313Cholesterol (Lipid) Panel $47CMP (Comprehensive Metabolic Panel) $47Comprehensive Female Panel $313Comprehensive Male Panel $218Diabetes Maintenance Panel $95Lipid Panel $47Osteoporosis Risk Panel $570Pre-Medication Prep Panel – Female $218Pre-Medication Prep Panel – Male $209Pre-Operative Panel – Female $218Pre-Operative Panel – Male $171Semaglutide Monitoring Panel $237STD Panel – Comprehensive $218Testosterone Panel $65.66Thyroid Panel (TSH, Free T3, Free T4) $95Cardiac Panel $68.995 Panel Rapid UDS $47PSA TOTAL $142Submit
