T Lab Inc. New Client Intake Form
Please complete this form so that we can establish you as a TLab ordering practitioner. Our staff will reach out to you with ordering instructions, specimen collection kit guidelines, and details on test result(s) delivery. If you have questions, please email us at info@tlabdx.com. Thank you for your interest. We look forward to serving you and your patients.

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Email *
Last Name *
First Name *
Middle Initial (optional)
Credential(s).  *
NPI Number (USA), License Number (Outside of USA) *
Practice Name (Optional)
Other practitioners within your practice who may order tests. (Last Name, First Name, (Middle Initial), Credential. (Optional)
States / Provinces in which you are licensed to practice medicine *
Professional societies with which you are associated (if any)
How did you hear about TLab? *
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