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How to Fill Out the Lab Requisition Form

Once you receive your test kit from the lab you will need to refer back to this page to complete the requisition form enclosed in the box.

Inside the test kit you will find the lab requisition form. We have simplified the information required for you to fill out.

  1. On the top left, in the Bill To section: check the Physician Account box.
  2. On the top right corner, check the Toxic Element Clearance Profile.
    The Comprehensive Urine Element Profile is NOT available at this time. DO NOT check the Comprehensive Urine Element Test.
  3. The Diagnosis Code is NOT required.
  4. Collection duration –Check the Timed box,
    For the Urine Challenge test, write 16 hours.
    For the Random Baseline test, write the amount of time you collected.
  5. It is NOT required to record the Total Volume of Urine.
  6. Under Provocation: For the Urine Challenge test, mark Post-Provocation
    or for the Random Baseline test, mark Pre-Provocation.
  7. Fill in Provocation Agent: "Zeolite"
    For Pre-Provocation, no agent is used so write "no agent used".
  8. Physician Signature is NOT required.
  9. Fill out Patient Information
  10. Important: Fill in Date Final Sample Collected.
  11. Be sure to sign form.
  12. Do NOT fill out the Insurance Information Section.
    Insurance and Medicare billing are not available though this site. This allows the cost of the test to remain inexpensive. If you wish to bill this type of testing to your health care insurance or Medicare, you must find a local health care provider to do the testing for you.
  13. Do NOT fill out Check or Credit Card Information. Your test is pre-paid through this web site.
  14. Follow instructions for collecting samples and placing in vials. It is NOT necessary to write Total Urine Volume on the vials of urine.
  15. Put the requisition form and the urine sample in the box.
  16. Call DHL toll-free at 1-800-225-5345 to schedule a pick-up.
  17. Refrigerate test kit until the day of pick-up. On the day of pick up it is okay to leave it on your door step until DHL arrives on that day.
  18. Do NOT fold the shipment bag. Pull the adhesive strip off from inside the bag on one side and press the bag together to seal.
  19. CRITICAL Once you ship the test kit to the lab, please send an e-mail to verythankful@gmail.com with "Shipped kit to lab" in the subject field along with the name of the person submitting the specimen for testing. Some folks take time to do the test and this will tell us that your results will be ready soon!

Some of the instructions on this site may seem contradictory when compared to the requisition form you receive. Please follow these instructions carefully and don't worry! The main concerns are outlined above for a successful collection and shipment.