If you are an ordering Clinician you can print the Test Requisition Forms out below. Or if you are a patient and want to fill out your Test Requisition Form before your appointment. These forms are fillable and use Adobe Acrobat.

• For Patients exhibiting COVID-19-like symptoms.

• Most Sensitive COVID- 19 Test, especially for individuals shedding very low levels of virus.

For screening multiple individuals for public health purposes (i.e. contact tracing)

• For screening asymptomatic employees
• Less sensitive than the Individual Test.

Detects antibodies from a current or previous COVID-19 infection.

• For Patients exhibiting COVID-19-like symptoms.
• Most Sensitive COVID-19 Test, especially for individuals shedding very low levels of virus.

For screening multiple individuals for public health purposes (i.e. contact tracing)

• For screening asymptomatic employees
• For Travel Purposes
• Less sensitive than the Individual Test.

Complete genome sequencing of the SARS-COV-2 virus to detect emerging variants of concern.

This panel of tests includes a comprehensive metabolic panel (CMP) that measures 14 different molecules in your blood, a complete blood count (CBC) that evaluates the cells that circulate in your blood, a routine urinalysis that measures several substances in your urine, and a lipid panel that measures the amount of different lipids (fat molecules) in your blood. These tests together may be used to evaluate your overall health, monitor your body’s reaction to certain treatments and medications or to help diagnose a variety of diseases and conditions, including diseases of the kidney, liver or bones, anemia, cardiovascular disease (CVD), diabetes, infections, inflammation, bleeding disorders and cancer.

This Panel includes the following tests:
Sodium
Potassium
Chloride
Glucose
Creatinine
Protein, Total
Albumin
Bicarbonate (CO2)
Alkaline Phosphatase (ALP)
Alanine Aminotransferase (ALT)
Aspartate Aminotransferase (AST)
Calcium
Blood Urea Nitrogen (BUN)
Bilirubin, Total
Phosphorus
Urinalysis, Routine
Lipid Panel (Chol, Tri-G, HDL, LDL)
LDL, Direct
Hemoglobin A1c (HbA1c)
Complete Blood Count (CBC) w/ Differential

The comprehensive metabolic panel (CMP) includes measurement of 14 different different molecules in your blood. It is used to evaluate your overall health, including liver function, kidney function, bone health and key nutrient levels.

This panel includes the following tests:
Sodium
Potassium
Chloride
Glucose
Creatinine
Protein, Total
Albumin
Bicarbonate (CO2)
Alkaline Phosphatase (ALP)
Alanine Aminotransferase (ALT)
Aspartate Aminotransferase (AST)
Calcium
Blood Urea Nitrogen (BUN)
Bilirubin, Total

This panel of tests may be used to help diagnose various anemias such as iron-deficiency anemia, hemochromatosis/hemosiderosis, hemolytic anemia, sideroblastic anemia and macrocytic/megaloblastic anemia, or to help diagnose iron overload/poisoning.

This panel includes the following tests:
Vitamin B12
Folate
Complete Blood Count (CBC) w/ Differential
Iron
Transferrin
Ferritin

This panel of tests may be used to help diagnose various anemias such as iron-deficiency anemia, hemochromatosis/hemosiderosis, hemolytic anemia, sideroblastic anemia and macrocytic/megaloblastic anemia, or to help diagnose iron overload/poisoning.

This panel includes the following tests:
Vitamin B12
Folate
Complete Blood Count (CBC) w/ Differential
Iron
Transferrin
Ferritin

Vitamin B12 (cobalamin) and folate (vitamin B9) are part of the B complex of vitamins necessary for normal red blood cell (RBC) and white blood cell (WBC) formation, repair of tissues and cells, and synthesis of DNA. This panel of tests may be used to detect vitamin B12 and folate deficiencies, such as in megaloblastic anemia.

This includes the following tests:
Vitamin B12
Folate

Alanine aminotransferase (ALT), is an enzyme that is found primarily in the liver. This test helps detect damage to the liver.

Albumin is a protein that helps carry vitamins, enzymes, and other important substances in your blood. This test may be used to help diagnose various health conditions, particularly those involving the liver and kidney.

Alkaline phosphatase (ALP) is an enzyme that is primarily found in the liver, bones, intestines, and kidneys. This test is usually used to identify health conditions in the liver or bones.

Aspartate aminotransferase (AST), is an enzyme that is found primarily in the liver, but is also found in other organs like the heart, kidneys and brain. This test is primarily used to detect damage to the liver, but may also indicate damage elsewhere in your body.

Bilirubin is an orange-yellow waste product made as a result of the normal breakdown of hemoglobin, which is found in red blood cells (RBCs). Bilirubin is ultimately processed by the liver so that it can be removed from the body. The direct bilirubin test is used to evaluate a person’s liver function or to identify problems in the bile ducts.

Bilirubin is an orange-yellow waste product made as a result of the normal breakdown of hemoglobin, which is found in red blood cells (RBCs). Bilirubin is ultimately processed by the liver so that it can be removed from the body. This test is used to evaluate a person’s liver function or to help diagnose anemias caused by RBC destruction (hemolytic anemia).

Urea (a.k.a. urea nitrogen) is a waste product that forms as part of the body’s natural process of breaking down proteins and is filtered out of the blood by the kidneys. A BUN test is most often interpreted together with creatinine to help assess the health of the kidneys.

Calcium is essential for cell signaling and the proper functioning of muscles, nerves, and the heart. It is also vital for blood clotting and the formation and health of bones and teeth. This test measures the amount of calcium in the blood.

The complete blood count (CBC) evaluates the cells that circulate in your blood. Red blood cells (RBCs) contain hemoglobin, a protein that transports oxygen throughout your body. White blood cells (WBCs) are an important part of the body’s immune system, protecting against infections and cancerous cells. Platelets are essential for normal blood clotting and healing after injury. The CBC test can be used to monitor your general health status, to monitor your body’s reaction to certain treatments and medications or to help diagnose a variety of diseases and conditions, including anemia, infections, inflammation, bleeding disorders and cancer (e.g., leukemia).

Creatinine is a waste product produced by your muscles and removed from your body by the kidneys. This test helps evaluate the overall health of your kidneys.

This test is used to indicate the presence of inflammation (usually due to injury, infection or some other disease) somewhere in your body.

Ferritin is the main protein in your body that stores iron. This test may be used to help diagnose iron-deficiency anemia or iron overload.

Folate (vitamin B9) is part of the B complex of vitamins necessary for normal red blood cell (RBC) and white blood cell (WBC) formation, repair of tissues and cells, and synthesis of DNA. This test may be used to detect folate deficiencies, such as in megaloblastic anemia.

Iron is an essential nutrient that helps make up hemoglobin, required for the transfer of oxygen throughout your body. This test may be used to help diagnose iron-deficiency anemia or iron overload.

Phosphorus is vital for energy production, muscle and nerve function, bone growth and maintaining your body’s acid-base balance.

Proteins are important building blocks of all cells and tissues, important for body growth, development, and health. Protein found in your blood is comprised of two main components, albumin and globulins. This test measures the amount of total protein in your blood.

Transferrin is the main protein in your blood that transports iron throughout your body. This test may be used to help diagnose iron-deficiency anemia or iron overload.

The urinalysis panel of tests is a group of physical, chemical, and microscopic tests that detect and/or measure several substances in the urine to help diagnose and/or monitor a variety of diseases and conditions, such as kidney disorders or urinary tract infections (UTIs).

Vitamin B12 (cobalamin) is part of the B complex of vitamins necessary for normal red blood cell (RBC) and white blood cell (WBC) formation, repair of tissues and cells, and synthesis of DNA. This test may be used to detect vitamin B12 deficiencies, such as in megaloblastic anemia.

This test may help determine if you have a Vitamin D deficiency. Adequate levels of Vitamin D are essential for healthy teeth and bones and a healthy immune system.

This test may help evaluate the proper function of your adrenal glands, detect adrenal cancer, or help determine the cause of masculine physical characteristics (virilization) in girls and women or early puberty in boys..

This panel of tests is used to help diagnose prediabetes and diabetes. Testing the levels of insulin can help differentiate between type I and type II diabetes or identify insulin resistance in prediabetes.

This Panel includes the following tests:
Glucose (Fasting)
Hemoglobin A1c (HbA1c)
Insulin

This panel of tests is used to help diagnose prediabetes and diabetes. Includes the following tests:
Glucose (Fasting)
Hemoglobin A1c (HbA1c)

This test measures the amount of glucose circulating in your blood and is generally used to help diagnose prediabetes, type I diabetes, type II diabetes, and gestational diabetes.

This test indirectly measures the amount of glucose in your blood, averaged over a 2-3 month period. It is used to help diagnose prediabetes and diabetes.

This test may help differentiate between type I and type II diabetes and identify insulin resistance, which can lead to type II diabetes, cardiovascular disease (CVD) and other negative health outcomes, if left untreated.

This panel of tests measures the amount of different lipids (fat molecules) and inflammation in your blood. The results together are used in both children and adults to evaluate risk of cardiovascular disease (CVD) like heart disease, heart attack, and stroke. One or more results that indicate higher risk may indicate the need to change your diet and/or lifestyle or necessitate other treatment options.

This Panel includes the following tests:

Lipid Panel (Chol, Tri-G, HDL, LDL)

LDL, Direct

C-Reactive Protein, Highly Sensitive (hsCRP)

Apolipoprotein B (ApoB)

This panel of tests measures the amount of different lipids (fat molecules) in your blood. It is used in both children and adults to evaluate risk of cardiovascular disease (CVD) like heart disease, heart attack, and stroke.

ApoB is a type of LDL. This test can be used with other lab tests to help determine risk of cardiovascular disease (CVD).

This test is used to indicate the presence of inflammation (usually due to injury, infection or some other disease) somewhere in your body.

This test is used to indicate the presence of very small amounts of inflammation in your body. This can be used with other lab tests to help determine risk of cardiovascular disease (CVD).

This test is a direct measurement of LDL cholesterol. This is particularly important when a person’s triglyceride levels are high (>250 mg/dL).

This panel of tests is used to evaluate the health of your liver and bile ducts and help diagnose disorders such as hepatitis, cirrhosis, bile duct blockage and alcohol abuse.

This Panel includes the following tests:

Albumin

Protein, Total

Alkaline Phosphatase (ALP)

Alanine Aminotransferase (ALT)

Aspartate Aminotransferase (AST)

Bilirubin, Total

Bilirubin, Direct

Gamma Glutamyl Transpeptidase (GGT)

This panel of tests is used to evaluate the health of your liver and help diagnose disorders such as hepatitis, cirrhosis and bile duct blockage.

This panel includes the following tests:

Albumin

Protein, Total

Alkaline Phosphatase (ALP)

Alanine Aminotransferase (ALT)

Aspartate Aminotransferase (AST)

Bilirubin, Total

Bilirubin, Direct

This test may be used to help diagnose a liver or bile duct disorder, differentiate between liver and bone disease as a cause of elevated alkaline phosphatase (ALP) or screen for/monitor alcohol abuse.

This panel of tests is used to help diagnose thyroid disorders or to monitor patients who are on treatment for hypothyroidism or hyperthyroidism.

This Panel Includes:
Thyroid Stimulating Hormone (TSH)
Free Thyroxine (FT4)
Free Triiodothyronine (FT3)

This panel of tests may be used to help diagnose an autoimmune thyroid disease, distinguishing it from other forms of thyroid dysfunction. It includes the two most common antibodies associated with autoimmune thyroid disease.
This panel includes the following tests:
Thyroperoxidase Antibody (TPOAb)
Thyroglobulin Antibody (TgAb)

This test is used to help diagnose thyroid disorders or to monitor patients who are on treatment for hypothyroidism or hyperthyroidism. An abnormally high or low level of TSH will be reflexed to FT3 and FT4 testing. $35, With Reflex $75

This test is used to help diagnose thyroid disorders or to monitor patients who are on treatment for hypothyroidism or hyperthyroidism.

This test is used to help diagnose thyroid disorders or to monitor patients who are on treatment for hypothyroidism or hyperthyroidism.

This test is used to help diagnose thyroid disorders or to monitor patients who are on treatment for hypothyroidism or hyperthyroidism.

This test may be used to help diagnose an autoimmune thyroid disease, distinguishing it from other forms of thyroid dysfunction.

This test may be used to help diagnose an autoimmune thyroid disease, distinguishing it from other forms of thyroid dysfunction.

This panel of tests focuses on a woman’s health, including: 1 – a panel of tests that help diagnose thyroid disorders; 2 – a panel of hormone tests that help evaluate a woman’s reproductive health, and; 3 – a cortisol test that helps diagnose disorders of the pituitary or adrenal glands.

This panel includes the following tests:
Thyroid Stimulating Hormone (TSH)
Free Thyroxine (FT4)
Free Triiodothyronine (FT3)
Estradiol
Progesterone
Prolactin
Follicle-stimulating Hormone (FSH)
Luteinizing Hormone (LH)
AMH
Testosterone, Total
Cortisol

This panel of hormone tests can be used to evaluate a variety of reproductive health issues such as: early or late onset of puberty, infertility, a woman’s menstrual and ovulation cycle, a woman’s ‘ovarian reserve’ (fertility potential), the health of a pregnancy, menopause, polycystic ovary syndrome (PCOS), hormone-producing tumors or hormone therapy.

This Panel includes the following tests:
Estradiol
Progesterone
Prolactin
Follicle-stimulating Hormone (FSH)
Luteinizing Hormone (LH)
AMH
Testosterone, Total

This panel of tests may help determine the cause of infertility, track your ovulation cycle, or evaluate the health of your reproductive organs (ovaries or testicles), or pituitary gland. It may also be used to evaluate early or delayed puberty in children.

This Panel Includes the following tests:
Follicle-stimulating Hormone (FSH)
Luteinizing Hormone (LH)

This test may be used to determine a woman’s ‘ovarian reserve’ (fertility potential) and menopausal status, help diagnose polycystic ovary syndrome (PCOS), or evaluate the effectiveness of ovarian cancer treatment.

This test measures or monitors estrogen levels in your body. It may be used when there are concerns about puberty, infertility, irregular menstrual cycles or menopause.

This test may confirm a pregnancy, help identify an ectopic pregnancy or monitor a pregnancy that may be at risk of failing.

This test may help determine the cause of infertility, or evaluate the health of your reproductive organs (ovaries or testicles), or pituitary gland. It may also be used to evaluate early or delayed puberty in children.

This test may help determine the cause of infertility, track your ovulation cycle, or evaluate the health of your reproductive organs (ovaries or testicles), or pituitary gland. It may also be used to evaluate early or delayed puberty in children.

This test can help determine the cause of infertility, track a woman’s ovulation cycle, monitor the health of a pregnancy (e.g., help diagnose an ectopic or otherwise failing pregnancy), help diagnose the cause of abnormal uterine bleeding, or monitor progesterone replacement therapy.

In women, this test may help diagnose unexplained flow of breast milk (galactorrhea), the absence of menstrual periods, or infertility. In men, this test may help diagnose the cause of erectile dysfunction. In both men and women, this test may help to detect or monitor a pituitary tumor that produces prolactin (prolactinoma).

In men, this test may help diagnose the cause of erectile dysfunction or infertility. In women, this test may help diagnose the cause of masculine physical features (virilization), excess body hair (hirsutism), infertility, or polycystic ovary syndrome (PCOS). In children, this test may help determine the cause of early or delayed puberty. This test may also be used to monitor testosterone levels in individuals undergoing hormone therapy.

This test may help diagnose disorders of the pituitary or adrenal glands, such as Cushing syndrome, or primary or secondary adrenal insufficiency (e.g., Addison disease).

This panel of tests focuses on a man’s health, including: 1 – a PSA test with reflex to prostate health index (phi) which is used to screen for possible cases of prostate cancer; 2 – testosterone testing that helps diagnose the cause of erectile dysfunction or infertility and is used to monitor testosterone levels in individuals undergoing hormone therapy; 3 – a FIT test that detects blood in a person’s stool and is generally used to screen for possible colon cancer.

With Reflex this Panel costs $250.

This Panel includes the following tests:
Prostate-specific Antigen (PSA)
Free PSA
p2PSA
Testosterone, Total
Sex Hormone Binding Globulin (SHBG)
Albumin
Testosterone, Free (calculated)
Fecal Occult Blood Test (FOBT)

The PSA test is often used to screen for possible cases of prostate cancer. If PSA is abnormally high, two other prostate cancer markers are included to help give a more accurate overall prediction of prostate cancer. The three markers together are called the prostate health index (phi).

This is $40 with reflex to Free PSA and p2PSA for a total of $150.

This panel of tests may help diagnose the cause of erectile dysfunction or infertility in men, and in women, help diagnose the cause of masculine physical features (virilization), excess body hair (hirsutism), infertility, or polycystic ovary syndrome (PCOS). In children, the results of this panel may help determine the cause of early or delayed puberty. This may also be used to monitor testosterone levels in individuals undergoing hormone therapy.

This Panel Includes the following tests:
Testosterone, Total
Sex Hormone Binding Globulin (SHBG)
Albumin
Testosterone, Free (calculated)

SHBG is a protein that transports a variety of hormones in the blood. This test helps determine the levels of different hormones (e.g., testosterone, estradiol) in your blood.

This test detects blood in a person’s stool and is generally used to screen for possible colon cancer.