Testing Order Form

Name *

First

Last

Date Of Birth *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Available Items

• Non Professional STD Test - $ 159.00
• Professional STD Test - $ 189.00

Individual Tests Priced Separately

Multiple Items

• Chlamydia -NG RNA, TMA - $ 60.00
• HB Surface AB/HB Core Antigen - $ 25.00
• Trichomonas Vaginalis Qual (male) - $ 60.00
• Trichomonas Vaginalis Qual (female) - $ 60.00
• Treponema pallidum AB, PA - $ 60.00
• HIV 1/2 antigen and antibodies Fourth GI - $ 40.00
• Hepatitis C AB - $ 18.00
• Syphilis - $ 20.00
• HSV 1 Tests for herpes simplex 1 which causes cold sores - $ 50.00
• HSV 2 Tests for herpes simplex 2 which causes genital herpes - $ 50.00
• HSV 1&2 - $ 85.00
• HAV Ab IgM Tests for Hepatitis A - $ 21.00
• HAV Ab total - $ 55.00
• HIV RNA TMA QL Tests for the presence of HIV genetic material in the blood(qualitative) - $ 175.00
• HIV RNA Tests for the same thing as above but also gives the amount of virus present(quantitative) - $ 165.00
• HCV RNA QN This test measures the amount of Hepatitis C virus in someone’s body - $ 200.00

Total Amount

$ 0.00

Comment or Message

Submit