Clinic Application Form
Name of clinic (You can add multiple clinics by clicking on + icon)
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Contact name
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Address (You can add multiple clinics address by clicking on + icon)
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Tel
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Email
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Upload Picture (JPG, PNG, GIF, PDF)
Booking system used
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Can we connect to it?
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Select
Yes
No
Are you selling blood at minute?
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Select
Yes
No
Would like information on selling bloods as Affiliate OR Practitioner?
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Select
Yes
No
I understand that the Phlebotomy fee of £35 is to be paid directly by the client and if a sample cannot be taken on the day, no fee will be charged.
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Submit Application