Virtual Consultation form | LaboratoryAssist

Virtual Consultation Service

How do virtual consults work?

In a virtual consult, a licensed provider will write an imaging order based on a virtual visit. A virtual consultation does not include a call and does not always allow for a back and forth discussion like a regular consult so you must be detailed and specific with your request. Once the order is generated, simply submit the lab order back to LaboratoryAssist, and we’ll take care of scheduling your labs.

What are the benefits of a virtual consult?

Virtual consults are quicker and more cost-effective than traditional in-person visits. However, they are not meant to replace the ongoing care provided by a primary care physician.

How long does it take to get a response?

After submitting your form, you should receive a referral within 2 business days.

Medical Necessity*

I understand that referrals are based on medical necessity guidelines. The medical provider could determine that alternate lab tests are needed.

No Guarantee*

There is no guarantee that participating labs can actually render the tests in the order written. No refunds will be provided.

Patient Information

Patient Name*

Please enter exactly as on your id. The name on the order can not be changed once issued.

First Last

Date of birth*

Gender*

Phone*

Email*

Address*

Street Address Address Line 2 City State Zip Code

Service is not available in this state.

Requested Lab Tests

Lab Tests Requested*

Add one test per line. Include test names only do not enter codes.
eg. Lipid Panel
If test codes are entered without the name of the test, provider will not write an order for that test.

Important: Only lab tests entered in this section will be on the order. If a test is only mentioned in the narrative below, it will not be added to your order.

Please provide a detailed narrative on why these tests are being requested?*

A detailed explanation for each test being requested must be provided.
One line responses are not sufficient. Aim to write at least a few paragraphs on the situation.
Ensure that you include at least the following:
Reason why you are requesting these tests
Previous diagnosis, conditions and symptoms
Other information that might be relevant for the physician to know

Important: Only lab tests entered in the "Lab Tests Requested" section will be considered for the order. If a test is only mentioned in this section, it will not be added to your order.

Please carefully review the lab tests requested

Any edits or additions to your requested tests will require a new additional consultation. To avoid delays or extra charges, ensure that your list is accurate and complete before proceeding.

Product Name*

Billing Address*

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Signature*

Hidden

ahg_la_user*

Email

This field is for validation purposes and should be left unchanged.

Virtual Consultation Service

How do virtual consults work?

What are the benefits of a virtual consult?

How long does it take to get a response?

Patient Information

Service is not available in this state.

Requested Lab Tests

Please carefully review the lab tests requested

Patients

Providers

Organizations

Organizations

Connect With Us

Learn About Our
Other Programs

Virtual Consultation Service

How do virtual consults work?

What are the benefits of a virtual consult?

How long does it take to get a response?

Patient Information

Service is not available in this state.

Requested Lab Tests

Please carefully review the lab tests requested

Patients

Providers

Organizations

Organizations

Connect With Us

Learn About Our Other Programs

Learn About Our
Other Programs