Contact form

<h3><em>***ORDER STATS***</em></h3>
<h3><br />Please enter in all STAT information here   ------&gt;</h3>
<p> </p>
<p>***(Before entering in your information, make sure you have your paperwork ready for the phlebotomist BEFORE SUBMITTING!)***</p>
<p> -Thank you</p>

name

*Fax number for results:

email

Patient First & Last Name

Patient DOB:

Patient Room #

address:full

phone

message

Simply Results LLC

Phlebotomy, blood work, specimen collection, STAT services and IV insertions/ IV replacements.

PT Serif

Jost

Rufina