Phone: 623-523-2260
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Phleb
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Mobile Phlebotomy
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Client Intake
Tell us a little about you.
Your information is kept private and HIPAA-protected. We use it to prep for your at-home blood draw.
Personal Information
First Name
*
Last Name
*
Date of Birth
*
Phone
*
Email
*
Service Address
Street Address
*
City
*
State
*
ZIP
*
Requested Service
Service Type
Select a service…
Early Morning Collection (6am–3pm) — $100
Short Notice Collection (5am–6am) — $125
Special Collections (Urine, Stool, Swabs) — $55
STAT Collection (within 48h) — $125
On-Call Collection — $125
Notes for the phlebotomist (optional)
I consent to GoPhlebLabs contacting me about this appointment and acknowledge the
privacy policy
.
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