Buy Kit | ImmunoProfile Customer Portal

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Minor must have their own email address and their own individual account for each purchase.
One Person per account and each account must have a unique email. Two or more people cannot share one email.
Only the Patient's name will appear on the Test Result Report
Physician prescription provided for each Test Kit purchased
Test Kits can only be purchased one at a time

Buy Kit

Shipping Info

Shipping Patient First Name

Shipping Patient Last Name

Shipping Address 1

Shipping Address 2

Shipping City

Shipping State

Shipping Zip

Billing Info (Parent/Guardian When Ordering On Behalf Of Minor Child)

Same as Shipping?

Billing First Name

Billing Last Name

Billing Address 1

Billing Address 2

Billing City

Billing State

Billing Zip

Phone

Email

Confirm Email

IMPORTANT: If you are a parent/guardian ordering for a minor, you must use a distinct email exclusively for the minor.

Are you ordering the Test Kit for yourself or your minor child?

Myself:

My Child:

Must be age 4+ to purchase and under the age of 18 you need a Parent or Guardian to consent to the purchase.

Patient First Name ?

Patient Last Name

Parent/Guardian Name ?

I am the parent or legal guardian of the Patient named above.

Patient Date of Birth ?

Patient Sex Assigned at Birth ?

Employer Healthcare Institution (Optional)

School (Optional)

Create Account

Provide a password to create an account to track your order and securely receive your test results

Password must contain minimum 4 characters and must contain both numeric and alphabetic characters

Password

Confirm Password

Discount Code

Price: $229.00

Tax:

Total: $229.00

Credit Card Info

Name on Card

Credit Card Number

Card Type

Expiration Month

We accept HSA/FSA payments Secure Payment

Secure Payment

Master Card

Discover

Am EX

Diners Club

JCB

CLIA Certified

CAP Accredited

American Product Made in USA

Expiration Year

Security Code What is this?

All test takers must be at least 4 years of age. Available for purchase in the 50 United States and Washington D.C. only.

Boxes must be checked to complete purchase and create account

Minor must have their own email address and their own individual account for each purchase.

One Person per account and each account must have a unique email. Two or more people cannot share one email.

I accept the Terms and Conditions and Privacy Policy

I consent to the collection and processing of my sample, or the sample of my minor child, in accordance with the Sample Processing Consent.

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