Complete Your Request

Pre-Authorize Payment

    Request Summary

    Requested Service
    QuantiFERON-TB Gold Test
    Lab testing fees $66.95
    Medical provider and platform fees $40.90

    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. Confirm Request and Agree to Terms

    Total Fees: $107.85

    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 and Consent to Telehealth.