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SPECIMEN ORDER FORM
PATIENTS NAME
HOME ADDRESS CITY STATE ZIP
PATIENTS DATE OF BIRTH
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PLEASE CHOOSE SERVICE
THERAPEUTIC PHLEBOTOMY
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ADDITIONAL INFORMATION
DOCTORS NAME /NUMBER
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INSTANT URINE COLLECTIN
DOT COLLECTION W/CCF
DOT NO CCF
NON DOT URINE
HAIR COLLECTION
Covid-19 antibody test
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Vital knowledge is a 100% minority, woman owned business, 8A certification pending
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