Medical Technology for Practice Management
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By clicking "Submit", you are requesting that the laboratory perform the complete toxicology panel as requested in your On Boarding packet, and that Dr. Ricky Lockett has authorized and requested these tests be performed for this patient.
Please make sure the label on the bottle has the name and DOB filled out. This requisition will NOT BE COMPLETE until you have included the printed DEMOGRAPHICS form and included it in the mailer package to be sent to the laboratory.
By clicking below I am acknowledging that all the information included here is true and accurate to the best of my knowledge.
Patient Authorization
RELEASE AND CONSENT