宅男福利社 | Student Wellness Center | Request for Lab Services

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    • Request for Lab Services

    Please complete the information below to request laboratory testing, such as those required for College of Nursing and other health programs.

    Available tests: Titers for Measles, Mumps, Rubella, Varicella, Hepatitis B & TB Quantiferon Gold Blood Test

    The order for testing will be sent to Quest Laboratories within 24 hours of your request (Monday-Friday only). You will receive an email at your 宅男福利社 email address with confirmation of tests ordered and instructions.

    *Student Last Name:

    *Student First Name:

    *Birth Date:

    *Sex: 
     Female
     Male

    Phone Number:

    University ID Number:

    宅男福利社 Email:

    *Student Type: 
     Off-campus commuting student (Please provide current address)
     On-campus Residential Student (indicate specific Residence Hall)

    If commuting student, provide current location with Street/City/State/Country
    Street:  
    		 City: 
    State:  
    		 Country: 

    If resident student, please provide residence hall:

    *Please indicate which tests you need to schedule.
     Measles Titer ($10.00)
     Mumps Titer ($10.00)
     Rubella Titer ($10.00)
     Varicella Titer ($10.00)
     Hepatitis B Titer ($15.00)
     TB Quantiferon ($55.00)

    Draw Fee ($5.00)
    This fee will be charged to your student account.

    Security Password (Please type the word ):
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