Kit Request Form

Specimen collection kits and culture test can only be ordered by licensed practitioners, as recognized by the laws of the state of Pennsylvania. This includes: MD, DO, PA‐C, CRNP, DC, DPM or a certified nurse midwife.

Required fields are indicated with an asterisk.

*First Name:
*Last Name:
*Type of Practice: Medical
Address 2:
Country: Only US-based physicians may order kits at this time.
*NPI: Enter 10 Digit #.
*Kit Requested: Borrelia Kit  
*Number of Kits Requested:
*How Did You Hear About Us?
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Security Code:

Advanced Laboratory Services Inc.
501 Elmwood Ave.
Sharon Hill, PA 19079

Phone 855-238-4949
Fax 855-238-4946
Borrelia Kit