Wellness Lab Preparation Checklist
Please complete this checklist to ensure you are fully prepared for your upcoming wellness lab appointment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Scheduled Lab Appointment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Pre-Lab Preparation Checklist (Please confirm each step you have completed)
*
I have fasted for the required period (if instructed)
I have avoided restricted foods/drinks (e.g., caffeine, alcohol) as instructed
I have taken/withheld medications as advised by my healthcare provider
I am well hydrated
I have brought a list of current medications and supplements
Other (please specify)
Additional Notes or Instructions (Optional)
I confirm that I have read and followed all the above preparation instructions to the best of my ability.
*
Yes, I confirm
No, I need further assistance
Submit Checklist
Should be Empty: