Putnam County Health Department Lab Draw Appointment Form

Putnam County Health Department Lab Draw Appointment Form

To schedule an appointment, please fill out the information below.
Contact Information
Name*

First NameLast Name
Address*

Street Address

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Date of Birth*
Gender

FemaleMaleOther
Payment Method*
We will not bill your health insurance for lab services.
Appointment Details
Please select an appointment date & time.*
Please drink adequate amounts of water the day before and day of your appointment.

Fasting labs should not eat after midnight and may have black coffee or water the day of the appointment.
Labs Requested*
prevnext( X )
Provider Ordered - Fee to be determinedMy provider will send orders for my labs. I understand that I will be contacted prior to my appointment to discuss the fee for services. Orders must be received at least 24 hours prior to your appointment.
$ Free



Wellness PanelCBC (Complete Blood Count), CMP (Complete Metabolic Panel), Hemoglobin A1C, Lipid Panel (Total Cholesterol, HDL, LDL, Triglycerides), Thyroid Panel - FASTING required
$25.00



CBCComplete Blood Count - Fasting
$5.00



CMPComplete Metabolic Panel - Fasting
$5.00



Thyroid PanelThyroid stimulating hormone, Free T4, Free T3
$10.00



Hemoglobin A1CHemoglobin A1C - Fasting
$5.00



Iron PanelPercent of saturation; serum iron; total iron binding capacity; unsaturated iron binding capacity
$5.00



Lipid Panel - FastingCholesterol, total; high-density lipoprotein (HDL) cholesterol; low-density lipoprotein (LDL) cholesterol (calculation); triglycerides; very low-density lipoprotein (VLDL) cholesterol (calculation)
$5.00



PSAProstate-specific Antigen
$5.00



TestosteroneTotal testosterone count
$5.00



Urine Analysis, without cultureUrine Analysis without culture
$5.00



Vitamin B12 & FolateFolate; vitamin B12
$12.00



Vitamin D 25Vitamin D, 25-Hydroxy
$15.00



Draw FeeFee assessed to cover cost of supplies and processing of specimens for preparation to be submitted to the lab for analysis. One fee per patient.
$10.00



Total

$0.00
If you need labs drawn that are not provided above, please contact our office. We will provide you with billing information prior to scheduling your appointment.

If you have any questions or need to cancel your appointment, please call the Putnam County Health Department at 660-947-2429.

We are open Monday through Friday from 8:00 am to 4:00 pm.

Located at 103 N. 18th St. in Unionville, MO 63565.

Services provided on a non-discriminatory basis. An equal opportunity provider.
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Putnam County Health Department Lab Draw Appointment Form

Contact Information

Appointment Details