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PHG PATHLABS
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Intake form
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Name
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Email address
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What type of service are you interested in?
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DNA paternity test
Pathology testing
General laboratory services
What is your preferred method of contact?
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Phone
Email
In-person consultation
What is your preferred appointment date?
What is your preferred appointment time?
Do you have any previous medical history we should be aware of?
How did you hear about us?
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Social media
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Are you a new or returning client?
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New client
Returning client
What is your age group?
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Under 18
18-30
31-45
46-60
Over 60
Which service or services are you interested in?
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Pathology testing
General Laboratory Services
Wellness clinic
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