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Your Local LAB for accurate detection of Bacterial, Viral and Fungal Pathogens that affect Human Health

3911 Hollywood Blvd, suite 202, Hollywood, FL 33021

Tel: (954) 251-3791

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Email: patients@labdistrict.com

New Physician’s Registration

Please fill out the following form to help us understand your needs.

Practice Name

Desired Start Date

Facility Contact Name

Ordering Physician’s Name

Ordering Physician’s NPI

Address

Phone

Fax

Facility Contact Number

Tests Requested with monthly volumes:

SARS-CoV-2 PCR

SARS-CoV-2 Rapid Test

SARS-CoV-2 Antibody (IgG/IgM)

RPP

UTI (PCR)

Women’s Health

Wound Care

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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3911 Hollywood Blvd, suite 202, Hollywood, FL 33021

Tel: (954) 251-3791

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