STEP-1 STEP-2 STEP-3 STEP-4 PATIENT INFORMATION FULL NAME EMAIL PHONE DATE OF BIRTH GENDER Male Female Other Prefer Not To Say Address NHS Number Doctor's Name TEST INFORMATION HEMATOLOGY Full Blood Count ESR ABO Blood Group PT, PTT & INR Extended Coagulation Anti coagulants Long Covid Dedicated Test SEROLOGY HIV ½ HEP B Ag HEP C Ab Syphilis Ab Basic Screening STD Panel Candida HPV MRSA Advanced Screening PATHOLOGY Urine Analysis Urine Analysis & Culture BIOCHEMISTRY Bone Markers Urea & Electrolytes Kidney Function Test Liver Function Test Inflammatory Panel Β – HCG (pregnancy test) CRP PSA Glucose HbA1c PROFILES Bio – Hem Profile ML Health Screening Diabetic Profile Lipid Profile Muscle Profile Vitamin Profile Thyroid Profile Iron Profile OTHER TESTS SAMPLE INFORMATION SAMPLE TYPE Blood Urine Stool Genital Swab Sputum Throat Swab SAMPLE DATE SAMPLE TIME IS THE PATIENT FASTING? Yes No OTHER INFORMATION Insurance Company Membership Number SHOW SUMMARY Some required Fields are emptyPlease check the highlighted fields. Submit Previous Step Next Step
