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**Chicago Fire Fighters Union - IAFF Local 2
Victus88 Test Kit Order Form

**Chicago Fire Fighters Union - IAFF Local 2
Victus88 Test Kit Order 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.

  • Patient Information
  • Allergy Symptoms Questionnaire
  • Insurance Information
    • Order Summary / Place Order

    PATIENT INFORMATION

    Please provide the primary patient information for each test kit you order (person taking the test). All fields are required.
    Name
    Name
    mm/dd/yyyy
    X feet, XX inches
    XXX lbs.
    Sex:
    Shipping Address:
    Shipping Address:
    Do you have any allergies to foods or medications?
    Are you currently taking any medications?
    Are there any health challenges you are currently facing?
    (i.e., injury, joint pain, frequent infection, digestive issues, or any other medical conditions/diagnoses)

    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.