ORDER LABS | BLOOD WORK REQUEST FORM

*We will email you an invoice
* A valid state issued photo i.d. is required by Labcorp prior to venipuncture (blood draw).

MOST POPULAR BLOOD TESTS

*There is a Minimum Order of $100 for lab work.
*Our staff will review your treatment and your health chart to determine which labs are appropriate at this time.
Testing includes *Complete Blood Cell Count (CBC), Total Testosterone, Estradiol, Sex Hormone Binding Globulin (SHBG), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Prolactin, and Prostate (PSA). *The CBC panel will provide a breakdown of: Red blood cell (RBC count), White blood cells (WBC count), Hemoglobin, Hematocrit, Average red blood cell size (MCV), Hemoglobin amount per red blood cell (MCH), Hemoglobin concentration per red blood cell (MCHC)
The Complete Blood Count (CBC) With Differential & Platelets test includes the following: Red blood cell (RBC count), White blood cells (WBC count), Hemoglobin, Hematocrit, Average red blood cell size (MCV), Hemoglobin amount per red blood cell (MCH), Hemoglobin concentration per red blood cell (MCHC)
Glucose: The primary type of sugar found in your blood. Calcium: A mineral essential to bone and muscle health. Total Protein: The total amount of proteins (including albumin) found in the blood that helps determine overall nutritional status. Albumin: The main protein that circulates in the blood, which provides tissue nourishment, carries substances (such as hormones and drugs) in the blood, and helps keep fluids within the blood vessels. Sodium: An electrically charged mineral (electrolyte) necessary for healthy muscle and nerve function that also helps maintain fluid balance. Potassium: An electrically charged mineral (electrolyte) vital to a cell’s ability to take in nutrients and remove waste; it is also essential for muscle function and regulating fluid balance. Carbon Dioxide (CO2): A waste product created by the body’s metabolism that helps maintain the body’s acid-base balance (pH) in the form of the electrolyte bicarbonate. Chloride: An electrically charged mineral (electrolyte) that helps regulate fluid and acid-base balance within the body. Alkaline Phosphatase: An enzyme found in the cells of the liver and other tissue. Alanine aminotransferase (ALT): An enzyme found mostly in the cells of the liver and kidney. Aspartate Aminotransferase (AST): An enzyme found in the cells throughout the body but mostly in the cells of the heart and liver. Bilirubin: A waste product produced by the liver as it breaks down red blood cells. Blood Urea Nitrogen (BUN): A protein waste product removed from the blood by the kidneys. Creatinine: A muscle-produced waste product filtered out by the kidneys. BUN/Creatinine Ratio: A comparison of BUN levels to creatinine levels, two waste products filtered by the kidneys. Globulin, Total: A measure of a group of proteins that function to help transport nutrients and help the body fight infections. A/G Ratio: A measure of the amount of albumin present compared to globulin present in the blood. Both albumin and globulin are proteins produced by the liver. eGFR (eGFR): A calculation (factored from your serum creatinine level, age, and gender) used to determine your level of kidney function; the higher your eGFR number, the better your kidneys are working; low results may be a sign of kidney disease. Thyroid Cascade Profile *Thyroid Stimulating Hormone (TSH), Triiodothyronine (T3) & Thyroxine (T4)

ADD-ON LABS

Select any number of additional testing that you would like.
*Please be as detailed as possible.