New Client Form

"*" indicates required fields

Account Demographics

Please fill all fields. Insert "N/A" if not applicable.
Hours of Operation:

Payer Mix % :

Logistics Information

Fedex Pick up:(days/time)
Initial Supply Order: (check all that apply)
Phlebotomist Needs: (check one)

Account Management

Clinical Director: Denise Perez
Company: Anchor Lab Services, LLC
Sales Phone: 404-481-5277 ext. 107
Sales Email:

Account Preference

Report Delivery Method:*
EMR Interface Request:
Hardware Request:*
Critical/Malignancy Calls:*

Supply Request

Billing Information

Click all that apply*
*DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Scroll to Top