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Your Personal Details
Gender:
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*
The normal range for blood tests is different for males and females. Gender is a required field.
First name:
*
Middle name:
Last name:
*
Date of birth:
Month
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Year
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Email:
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Your email address will be your login ID.
Confirm Email:
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Last 4 digits of your SSN:
*
The last 4 digits of your SSN are required.
Your Address
Street address 1:
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Street address 2:
ZIP / postal code:
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City:
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Country:
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State / Province:
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AP (Armed Forces Pacific)
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Your Contact Information
Phone Type:
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Phone:
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Milestone Health Direct may need to contact you about your results. Please provide the best phone number for us to reach you.
Options
Referrer Code:
Communication Preference
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Receive on SMS Text Message when your Lab results are ready
Enter a Mobile Phone number where we can send SMS Text Messages. Standard text messaging rates apply
I wish to receive my lab requisition via email
(By un-checking this box you will need to either print your lab requisition or be able to show it on your cell phone when you arrive at a PSC)
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