Date of Birth
Fighter's Email Address
IMPORTANT NOTE: This Email Address MUST belong to the Fighter who's name is mentioned above. If you are a not the fighter, DO NOT place your email address here, as this is the email address used in reporting the results.
It is against federal law to illegally obtain medical records or results without prior consent, in the form of a medical release form, being legally signed by the patient.
Pro or Amateur?
Select One Pro Amateur
Date of Event
State (where event is located)
Promotion Company Name
Promoter's Contact Name
Promoter's Phone Number
Promoter's Fax Number
Promoter's Email Address
Gym / Manager Information
Gym Phone Number
Gym Zip Code
Blood Work Information
Which test would you like to order?
Combative Trio (HIV, HEP B&C) - $70 Combative Trio + CBC - $129 Combative Trio + CBC + HCG (Pregnancy) - $174 Combative Trio + CBC + PT/PTT - $164 CBC Only - $40 PT/PTT Only - $35 HEP B Only - $35 HEP C Only - $45 HIV Only - $55
Who is paying for this blood work order?
Please enter the full name of the person paying for this blood work order
Terms of Service & Conditions
Advanced Sports Labs will be contacting you by email and phone to confirm this order. Advanced Sports Labs protects the privacy of our clients and will not sell, distribute, or share any information about our clients with third party's at anytime. In the Event of a Positive Result, on any blood work Advanced Sports Labs provides, we recommend that the patient consults with their personal physician.
IMPORTANT NOTE: The laboratory is obligated by federal law to report any positive HIV results to the proper authorities. If further testing for confirmation purposes is required, Advanced Sports Labs has the authorization to charge additional fees for further testing and it will be charge to the credit card on file. If for any reason you need to cancel your blood work order, a $15 administrative fee will be deducted from the amount paid and the refund will be processed within 5 business days of cancellation.
IMPORTANT NOTE: WE CANNOT PROCESS ORDERS FOR NEW YORK, NEW JERSEY & RHODE ISLAND DUE TO STATE REGULATIONS.
I hereby acknowledge that I have read and accept the terms of service & conditions stated above. If further testing is required, I authorize Advanced Sports Labs to charge my credit card on file for additional fees for further testing.