FAST LAB

25%

Patient Information
First Name*
Middle Initial
Last Name*
Email*
Phone
If ordering a test for a minor: You must register with a separate email address for the minor or use the minor’s demographic information. Please make sure the minor’s insurance information is provided in the registration process, not your own.

Address
Home Address*
Apartment, Suite, Office
City*
State*
Zip*
same address
Use home address as shipping address.
Shipping Address*
Apartment, Suite, Office
City*
State*
Zip*
Passport Information (for Travel)
using for travel
Are you using this for travel? (Check if yes)
Passport Number

Not all countries require a passport number but providing this will make it easier for you when boarding your flight.
Outgoing Shipping*
For faster delivery, please upgrade your outgoing shipping
Return Shipping*
For faster returns, please upgrade your returns shipping
Date of Birth*
This information is needed for your test result PDF.
Gender*
This information is needed for your test result PDF.
Parent or guardian
(if below 18 years of age)
First Name
Last Name
Race & Ethnicity*
(Check all that apply)
- American Indian or Alaska Native
- Native Hawaiian or other Pacific Islander
- Asian
- White
- Black or African American
- Hispanic or Latino
- Two or more races
- Other Race
- Prefer not to answer
Terms of Use and Privacy Policy*
I have read and accept Fast Lab Tech’s Terms of Use and Privacy Policy*

Review Order
Please review your information below and ensure all information is correct before placing your order.

Important: The person named below must be the person who is taking the test
{all_fields:nohidden}

Input your search keywords and press Enter.

Patient Information

Address