Account Setup Form

Note: All information with a red asterisk ( * ) must be completed

Patient Information
Month: Day: Year:



Specimen Information



Medical Necessity

PATIENT SIGNATURE:

For non-touch screen devices, the patient needs to type their full name below, and provide a secondary identifier.

By selecting the Add Signature button, I attest that I approve of this digital signature

I hereby authorize the laboratory, NovaDx, to collect, analyze, and report my results for my submitted specimens for testing. I understand that a biologic specimen (blood, urine, swabs, sputum, and/or saliva) will be obtained from me. Read more