New Account Setup Application
- To order tests, the practitioner must be authorized under his or her scope of practice.
- The ability to order laboratory testing is linked to a profession’s authority to interpret results for the purposes of diagnosis for decisions regarding patient treatment. If you are unsure whether your license covers the ordering of laboratory tests, please contact your State Department of Health, Health Professions Quality Assurance.
- Please do not refresh the page while completing the form.
- You may fill out our secure Registration Form below and submit when all required fields are completed.
- This Practitioner Certification Form is available in PDF format.
You may print and complete the form. The completed form may be mailed, faxed or emailed to our Client Services Department.