Patient name (required) Gender (required) MaleFemale Mobile No. (required) Medical Record No. (if any) Phone No. Email Disclaimer: With this form, you are submitting a request for booking your home sampling for laboratory tests. Our Call Centre representative will get in touch with you on the given contact details shortly to collect lab tests details & align the visit accordingly. You may be asked to share doctors’ lab test prescription to confirm the name of the tests. You are requested to cooperate with our staff. Thank you!
