Physician Requests | Kelso Labs

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Collins Ave (242) 322-7994

Village Road (242) 394-7715

Palmdale (242) 603-1775

Spanish Wells (242) 699-5740

NOTICE: Our Carmichael Rd. branch is closed. We will be opening another branch in the Carmichael Rd. area in the near future. MASKS ARE REQUIRED FOR ENTRY as of Oct. 1, 2022 by Government Mandate.

PHYSICIAN REQUEST FORM

Patient First Name*
Patient Last Name*
Doctor*
Date of Birth*
ICD Code or Diagnosis*
Date*
Tests*
- SMA 25
- CMP
- BMP
- FBS
- LIPIDS
- CBC
- HBA1C
- PSA
- CA125
- FT/TSH
- CRP
- VDRL
- HBSAG
- HCV
- HIV
- URINALYSIS
- MSU
- PT/INR
- PTT
- ANNUAL PROF (SMA,CBC,VDRL, MSU)
- CARDIAC PROF (CK,AST,LDH)
- LIVER PROF
- OB PROF
- RENAL PROF
- EKG
Additional Tests or Information

Accepted Insurances

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