Complete Your Request

Pre-Authorize Payment of Virtual Consult Fees

    Request Summary

    Requested Service
    Chlamydia / Gonorrhea RNA Test
    HIV 1 & 2 Ab Test
    HSV 1 & 2 Ab (IgG) Test
    Hepatitis B Surface Antigen Test
    Hepatitis C Antibody Test
    RPR Test
    Doctor's Lab Order (included)
    Lab Collection Fees (included)
    Total Fees: $264.68

    Complete the form below to submit your request. All fields are required.

    1. Choose Testing Location

    Enter your Zip Code to see a list of available Quest Diagnostics lab locations in your area.

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    Your Selected Lab

    2. Patient Demographic Information

    3. Patient Health Information

    4. Secure Payment

    5. Confirm Request and Agree to Terms

    Total Fees: $264.68

    Total fees include the lab order, all lab fees, and a copy of the results. By clicking "Submit Request", you indicate that you, as the patient or legal guardian of the patient, agree:

    1. to follow up with my regular medical provider for ongoing care;
    2. to the best of my knowledge, all information submitted is accurate;
    3. to the Terms of Service.