Order Tests

Patient Name

First Last

If you are ordering more than one test for multiple children, please submit one child's name.

Contact Information

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Mailing Address (Where you want your medical kit shipped)(Required)

Street Address Address Line 2 City State ZIP Code

Ordering Information

Pricing below reflects product cost plus sales tax. Shipping is a flat fee added at the bottom of the form. Please select which test(s) you would like and the quantity.

Please select type of order(Required)

Rapid Strep Test

Strep (Required)

Price: $26.63

You must add a quantity of how many test(s) you are ordering.

Payment Information

Processing & Handling

Price:

Total

Credit Card

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Order Tests

Order Tests

Patient Name

Contact Information

Ordering Information

Payment Information

We’re Here To Help Your Family

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