Onboarding

Client Feasibility Evaluation

Provider Facility Full, Legal Name *

Medical Practice Specialty *

Full Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Patient Volume - Daily

Selected Value: 0

Daily Average

Patient Volume - Monthly

Selected Value: 0

Monthly Average

Blood Draws - Daily

Selected Value: 0

Daily Average

Blood Draws - Monthly

Selected Value: 0

Monthly Average

Urine Toxicology - Daily

Selected Value: 0

Daily Average

Urine Toxicology - Monthly

Selected Value: 0

Monthly Average

Pap Smears - Daily

Selected Value: 0

Daily Average

Pap Smears - Monthly

Selected Value: 0

Monthly Average

Infectious Disease - Daily

Selected Value: 0

Daily Average

Infectious Disease - Monthly

Selected Value: 0

Monthly Average

Oral Toxicology - Daily

Selected Value: 0

Daily Average

Oral Toxicology - Monthly

Selected Value: 0

Monthly Average

When is the client expecting to start sending samples? *

Name *

Please provide a clinic contact to initiate the implementation and training scheduling.

Title/Clinic Role *

Contact Number *

Email *

Does the client have a current lab? *

Yes
No

Please provide collector contact information.

Name *

Contact Number *

Email *

Comment or Message *

FURTHER INQUIRY AND EVALUATION WILL BE NECESSARY IF ANY OF THE ITEMS LISTED ARE TO BE PROVIDED.

Apollo Laboratories now operates an official Roche Total Antibody Test Site

We look forward to seeing you

You will receive a confirmation when your paperwork has been accepted.

Onboarding

Client Feasibility Evaluation

Apollo Laboratories now operates an official Roche Total Antibody Test Site

We look forward to seeing you

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