gene_iq-lab-web

FOR PHYSICIANS

Provider Service Agreement COVID-19

I accept responsibility for the ordering of COVID-19 testing from my office to be sent to Gene-IQ’s Lab. I will still provide a Requisition with each sample, which should be deemed as my written request to perform the specified test. I acknowledge that my PSA information will be saved in Gene-IQ’s Lab system for future possible testing requests, and that I will contact Gene-IQ if I would like to end this electronic authorization agreement.

Physical Location

PHYSICIAN SIGNATURE

Once the information on your PSA has been verified, you will receive an email with an authorization code and a direct link to Gene-IQ’s ordering page for COVID-19 testing. 

1-800-978-9805

972-942-0110

 

info@geneiqlab.com
 

3716 STANDRIDGE DR SUITE 204

THE COLONY, TEXAS 75056

CLIA #45D2181504

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