Rupa Lab Orders | Ultimate WellnessPro

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Our skilled Specialists and staff will strive to make your appointment an excellent

healthcare experience.

Order today and let’s discuss your need for lab services.

Rupa Health Service Request:

Patient First Name*

Patient Last Name*

Birthday:

Email Address*

Clinic / Provider Info:

Appointment Date (Preferred)*

Appointment Date (2nd Choice)

Preferred Time

Preferred Time (2nd Choice)

Do you have lab kit on hand? Required

YES

NO

Lab Kit Name

Upload Requisition/ Order Form

Upload supported file (Max 15MB)

Upload Additional File

Upload supported file (Max 15MB)

Upload Additional File

Upload supported file (Max 15MB)

Upload Additional File

Upload supported file (Max 15MB)

Upload Additional File

Upload supported file (Max 15MB)

Upload Additional File

Upload supported file (Max 15MB)

I accept terms & conditions: Policy Terms When scheduling your appointment request, please note that this booking is not the official confirmation. One of our customer care team members will give you a call within 24/48 hours. *Extra Lab Kits will incur an additional fee. Please note that all invoices are to be paid upon receiving the invoice. UWP will not hold your appointment slot if payment is not received within 48hrs of receiving your invoice. You will then have to reschedule your appointment. We can not guarantee that the original time/date will be available if you miss payment. Please note, there will be no refunds on patient no shows and on any service rendered. The Phlebotomy companies UWP outsource to are independent 3rd party companies and not a part of Ultimate Wellness Providers Co. Booking an appointment is provided as a courtesy to patients and providers. Patients will be contacted by the assigned Phlebotomy providers directly for confirmation and appointment availability. Ultimate Wellness Providers assumes no responsibility or liability for fees or services provided by the assigned Phlebotomy Companies.

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