Order a Test - Precision Diagnostic Lab

Test Reqest Form

Fill out the request form below to order a test. You will be contacted shortly afterwards to verify your order.

Patient Name

Gender

Female

Male

Your gender is required.

Date of Birth

Your date of birth is required.

ⓘ Example: 27 Jan 1975

Address

Diagnosis

Clinical Indication

Mobile Number

ⓘ Ensure accuracy of Contact Information, it will be used for Order Confirmation and Results Delivery.

Specimen Type

Collection Date

Institution Name

Institution Address

Institution Phone

Requesting Physician