Blood Test Request – CRM

Request ID

Clinic Ref ID

Partner Reference ID

Let's get started!

Follow these simple steps:

Choose Your Location: Select a convenient location or gym blood clinic where you’d like to have your blood test done.
Select the Date & Time: Pick a suitable date and time slot for your appointment.
Enter your Details: Complete your personal details.
Select your Lab Product: Select the Blood Test profile you have chosen.
Pay for Your Test: Once you’ve made your selections, proceed with payment.

Phlebotomist Required

No

Yes

If you require a phlebotomist for this blood test, select Yes and then select a suitable location, date and time.

Appointment Selection

Schedule Blood Test

Patient Details

Patient Name

First

Last

D.O.B

Gender at Birth

Patient Email

Phone

Patient Address

Line 1

Line 2

City

County

Post Code

Patient Address

Additional Clinician Email

Yes

No

Additional Clinic Email

Products

Please select the Blood Profiles you require.

Blood Test Types

Blood Profiles

A-Z Blood Test

Please select the blood test types you require. You can order both Blood Profiles and Blood Tests

Sub-Total

£

Order Summary

Standard Phlebotomist Charge

£

Discount Code

Do you have a Discount Code?

Discount Amount

%

Total

£

Payment

Please now provide your payment details. Once submitted, your Blood Test Order will be confirmed and you will receive two emails;

Confirmation of Order
Confirmation of Booking - Date, Time and Venue

Payment

Your credit card information is processed securely by using the PCI DSS standards. This ensures that your data is protected from unauthorized access and potential fraud.

Credit Terms Agreed:

Please note as you have agreed Credit Terms, once this form is submitted you will be sent an electronic Invoice for this Blood Test Request.

Start Over