Hit enter to search or ESC to close
1-877-331-6414
EXT: *100
Home
About Us
Services
Purpose & Procedures
Faxable Lab Form
Blogs
Book An Appointment
Contact Us
Login
Register
Thank you for connecting with TABS Adult ADHD & Anxiety Telemedicine Specialists, LLC We will respond to you shortly.
1
0%
https://tabsadultadhdtelemedicine.com/wp-content/plugins/nex-forms
false
message
https://tabsadultadhdtelemedicine.com/wp-admin/admin-ajax.php
https://tabsadultadhdtelemedicine.com/faxable-lab-form
yes
Instructions for patient: Please take this order form to your local laboratory for blood draw. Ensure you bring your insurance information and I.D. with you.
Instructions for lab:
Your Fax Number
*Your Email Address
Patient Information:
*First Name
*Last Name
Date of Birth
*Phone Number
Address
State
Zip
Medical Provider Information:
*Medical Providers name
NPI#
Signature
Date
Lab Orders:
--- Select ---
Standard order set #1
Standard order set #2
Standard order set #3
Additional Labs:
Dx Code:
Submit
Home
About Us
Services
Purpose & Procedures
Faxable Lab Form
Blogs
Book An Appointment
Contact Us
Login
Register
1-877-331-6414
