This information will be used to send your test kit and/or contact you for any problems or questions with your order. (All order information and test results remain strictly confidential and are never released to any outside party.) A coded invoice will be available for submission to your insurance company for reimbursement of EnteroLab's tests by clicking the 'View Order Status' button on the left menu once your order has been placed.

NAME AND DATE OF BIRTH ON THE ORDER MUST BE FOR THE PERSON BEING TESTED (NOT NECESSARILY THE PERSON ENTERING THE INFORMATION). SAMPLES RETURNED TO THE LAB WITH THE WRONG NAME CANNOT BE PROCESSED.

All fields with * are required.

*First Name

(First Name of person being tested)

Middle Name

(Middle Name of person being tested)

*Last Name

(Last Name of person being tested)

*Birth Date

(mm/dd/yyyy) (Birth Date of person being tested)

*Sex

Male

Female

(Sex of person being tested)

(Necessary to receive order confirmation and notice of posted results via email)

*Primary Phone

Secondary Phone

Work Phone

*Shipping Address 1

Shipping Address 2

*City

*State

(Please use 2-letter state abbreviation for United States)

*Zip

*Country

*User ID

(Any combination of letters and/or numbers)

*Password

*Retype Password

Welcome to the EnteroLab Test order registration page. Fill out the form below to enter your EnteroLab profile. This can be used at any time to access the status of your test or for future test ordering. When you have completed the form, click the "Submit" button to proceed to the next step.