HTLV I-II BY PCR

Email*

Phone number*

Select your preferred campus*
—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Tell us more
Para evitar que tu solicitud sea marcada como spam, escribe al menos 15 caracteres en este mensaje.

Email*

Phone number*

Select your preferred campus*
—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Invoice date*

Patient's official ID* If the patient is a minor, please attach a parent or legal guardian's ID. (PDF, JPG)

Email*

Phone number*

Select your preferred campus*
—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Invoice date*

Patient's official ID* If the patient is a minor, please attach a parent or legal guardian's ID. (PDF, JPG)

Email*

Phone number*

Select your preferred campus*
—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Date the study was performed*

Patient's official ID* If the patient is a minor, please attach a parent or legal guardian's ID. (PDF, JPG)

Email*

Phone number*

Select your preferred campus*
—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Prescription or medical order*

Email*

Phone number*

Select your preferred campus*
—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Invoice to be modified*

Tax ID (RFC)*

Full name or legal business name*

Tax address*

Patient's official ID* If the patient is a minor, please attach a parent or legal guardian's ID.

Note: Invoices are not issued to insurance companies. Please attach your Tax Status Certificate (Constancia de Situación Fiscal).