Great Lakes Medical Lab Advance Cash Payment Service

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Confirmation ID

Service*

COVID-19 rt-PCR Testing

AditxtScore™ for COVID-19Option

COVID-19 Rapid Antibody IGG/IGM Testing - 15 minute results

Mobile Phlebotomy

CBC with Auto Diff

Comprehensive Metabolic Panel

Lipid Panel

Hemoglobin A1C

VITAMIN D

UA Dip

Basic Metabolic Panel

CBC without Diff

UA Microscopic

Sed Rate

C-REACTIVE PROTEIN (CRP)

Acute Hepatitis Panel

STD Panel

PT

Thyroid Panel

Hepatic (Liver) Panel

ANA Screen

APTT

Influenza A & B

Renal Function

STD Plus Panel

Vaginitis Panel

STD/Vaginitis Panel

Strep A molecular

COVID Plus Flu by PCR

Influenza A & B Panel

GLML Respiratory Panel by rt-PCR

Respiratory Syncytial Virus

Measles (Rubeola) IGG

Mumps

Rubella

Syphillis

Quantiferon

Gonorrhea

Varicella-Zoster Virus Antibodies (IgG)

Patient Information

Name*

First Last

Date Of Birth*

MM slash DD slash YYYY

Email*

Phone*

Address

Street Address Address Line 2 City State ZIP Code

Organization/ Medical Facility Name*

Payment

Transaction Fees*

Transaction and Administrative fees are non-refundable

Price: $0.00

Total

Consent*

I consent that I am seeking this test for traveling, a non-medically necessary reason, or do not want to provide the insurance information for reimbursement. I consent to pay the cash price in advance.
I understand that the laboratory is unable to provide a receipt that contains the information generally required by health plans for reimbursement.

I agree

Credit Card

Card Details

Cardholder Name

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