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.Format: (000) 000-0000.
Email
You will receive notification from LabCorp when your results are available.
Date of Birth
Gender

Other
Payment Method
We will not bill your health insurance for lab services.
Primary Care Provider
Please provider the name of your healthcare provider. A copy of your results will be shared with them.
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 determined
My 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 Panel
CBC (Complete Blood Count), CMP (Complete Metabolic Panel), Hemoglobin A1C, Lipid Panel (Total Cholesterol, HDL, LDL, Triglycerides), Thyroid Panel - FASTING required

$25.00



CBC
Complete Blood Count - Fasting

$5.00



CMP
Complete Metabolic Panel - Fasting

$5.00



Thyroid Panel
Thyroid stimulating hormone, Free T4, Free T3

$10.00



Hemoglobin A1C
Hemoglobin A1C - Fasting

$5.00



Iron Panel
Percent of saturation; serum iron; total iron binding capacity; unsaturated iron binding capacity

$5.00



Lipid Panel - Fasting
Cholesterol, total; high-density lipoprotein (HDL) cholesterol; low-density lipoprotein (LDL) cholesterol (calculation); triglycerides; very low-density lipoprotein (VLDL) cholesterol (calculation)

$5.00



PSA
Prostate-specific Antigen

$5.00



Testosterone
Total testosterone count

$5.00



Urine Analysis, without culture
Urine Analysis without culture

$5.00



Vitamin B12 & Folate
Folate; vitamin B12

$12.00



Vitamin D 25
Vitamin D, 25-Hydroxy

$15.00



Colorectal Screening - Medicare Covered
This service is offered through Guardant Shield for persons ages 45-85 with no cancer and no colonoscopy in the last 12 months. Health insurance is required and will be billed for the test. If you have questions regarding coverage, please contact your insurance provider.

Cash price is $1,495.00 with payment required prior to the sample being analyzed.

Free



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

$20.00



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.
Should be Empty:

Putnam County Health Department Lab Draw Appointment Form

Contact Information

Appointment Details

Labs Requested*

Labs Requested