Complete Your Request

Pre-Authorize Payment

Request Summary

Requested Service
Lead Test
Lab testing fees $19.58
Medical provider and platform fees $32.62
Total:$52.20

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

1. Choose Testing Location

Enter your Zip Code or city 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. Confirm Request and Agree to Terms

Total Fees: $52.20

Total fees include the lab order, all lab fees, and a copy of the results.

After you submit your request, a licensed medical provider in your area will review your information. You will be notified by email when that provider has reviewed your request and, if appropriate, made care recommendations.

By clicking the "Submit Request" button below, you indicate that you, as the patient or legal guardian of the patient, agree to the Terms of Service, Privacy Policy and Consent to Telehealth.