Local2 Order | Biovision Diagnostics

Victus88 Test Kit Request Form

Please complete this form in its entirety, providing all required information for each test kit you are ordering. Your test kit will arrive within 5-7 business days.
NOTE: You must enter unique patient information for each test kit that you order.

* CFF/CPD Victus88 Test Kit Request Form

Patient Information
Insurance Information
Order Summary / Request Consult

PATIENT INFORMATION

Please provide the primary patient information for each test kit you order (person taking the test). All fields are required.

Name

Email Address

Mobile Phone

Date of Birth

mm/dd/yyyy

Sex:

Male

Female

Shipping Address:

If you are human, leave this field blank.

If you have any questions or require assistance with completing this form, please contact Biovision Diagnostics Client Services at help@biovisiondx.com or call (618) 690-9555.