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NORTH SOUND MOBILE PHLEBOTOMY LLC

Client Registration & Blood Collection Request

Your blood draw. Your location. Your convenience.

Welcome to North Sound Mobile Phlebotomy.

Thank you for choosing North Sound Mobile Phlebotomy LLC for your mobile blood collection needs.

Complete the form below to request a blood draw at your home, care facility, workplace, or another approved collection location.

Please note: Submitting this form does not confirm an appointment. Our team will review your request and contact you to confirm availability, pricing, and next steps.

Client Legal Name

Last Name

Date of Birth

Client Type

Name of Person Completing This Form

Relationship to Client

Client Phone Number

Client Email Address

Preferred Method of Contact

Phone Call Email Text Message

Is this blood collection requested by a healthcare provider?

Yes No I need assistance understanding the requirements

Ordering Doctor / Healthcare Provider's Name

Doctor's Office / Clinic Name

Doctor's Office Phone Number

Doctor's Office Fax Number

Laboratory Name

Quest Diagnostics Labcorp Other Laboratory Not Sure

Laboratory Order Status

I have a laboratory order My doctor's office will provide the order I need to confirm the order requirements Other

How Will You Provide the Laboratory Order?

Secure Upload My Healthcare Provider Will Send It I Need Instructions

Laboratory Order or Test Information

Please provide the actual laboratory order through the secure method provided by our company. Do not enter unnecessary medical history or sensitive medical details in this field.

What Type of Collection Service Do You Need?

How Many Patients Need Collection at This Location?

Requested Collection Date

Preferred Time

Is Fasting Required?

Yes No Not Sure

Special Collection Requirements

Please note that specialized collections, certain tests, and STAT requests require review before acceptance.

Where Would You Like the Blood Draw?

Collection Street Address

Apartment / Unit / Room Number

City

State

ZIP Code

Your location may be outside our included 25-mile service radius. Additional travel charges may apply. Our team will confirm any additional charges before your appointment is confirmed.

Is This the Same Address as the Client's Mailing Address?

Yes No

Parking, Building Access, or Location Instructions

Is the Collection Location Within Our Service Area?

Yes Not Sure No / Please Check Availability

Our primary service area includes Snohomish, Skagit, Whatcom, and Island counties in Washington. Requests outside our regular service area may be reviewed individually. Travel charges may apply depending on the collection address, distance, and service requirements.

Who Will Pay for the Service?

Billing Contact Name

Billing Contact Email

Billing Contact Phone

How Our Pricing Works Our service quote may depend on the collection type, number of patients, collection requirements, service availability, and distance from our service area. After reviewing your request, North Sound Mobile Phlebotomy LLC will contact you with the applicable service fee, any travel charges, and the total estimated cost. No payment is due when you submit this request. Please wait for our team to confirm the price and explain the available payment method before making a payment. Laboratory testing fees are separate unless expressly included in your written quote. We do not guarantee insurance reimbursement.

How Did You Hear About North Sound Mobile Phlebotomy?

Additional Comments or Requests

Consent to Contact

I authorize North Sound Mobile Phlebotomy LLC to contact me regarding this service request using the contact information I provided.

Acknowledgment

I understand that submitting this form is a request for service and does not confirm an appointment, guarantee service availability, or establish a final price. I understand that my request must be reviewed before the company confirms the service and payment details.

Authorization to Submit Information on Behalf of the Client

If I am submitting this request for another person, I confirm that I am authorized to provide the information and communicate with the company on that person's behalf.

Privacy Notice: The information submitted will be used to review and coordinate your requested service, communicate with you, and prepare a quote. Please do not submit unnecessary sensitive medical information. Laboratory orders and other medical documents should be submitted through an approved secure method.

We have received your blood collection service request. We appreciate the opportunity to assist you with convenient mobile blood collection services at your preferred location.
What Happens Next?

Our team will review your submitted information, including your requested collection service, laboratory requirements, collection location, and preferred date.

We will then contact you to:

Review the details of your request.

Confirm service availability and any required laboratory documentation.

Determine applicable travel charges based on your collection address.

Provide your service quote and total estimated cost.

Discuss appointment scheduling and payment instructions.

Please note: This email confirms receipt of your request only. It is not an appointment confirmation, a final price quote, or a payment receipt. Please wait for our team to confirm your service details before making any payment.

If we need additional information, we will contact you using the details you provided.

Thank you for choosing North Sound Mobile Phlebotomy LLC.

Your blood draw. Your location. Your convenience.

North Sound Mobile Phlebotomy LLC
Phone: 360-217-9922
Email: contact@northsoundmobilephlebotomy.com
Website: northsoundmobilephlebotomy.com

Professional mobile blood collection at your convenience.

Our Service Pricing

Your blood draw. Your location. Your convenience. Mobile Blood Collection Services

Routine Mobile Blood Draw — $95
Same-Day / STAT Mobile Blood Draw — $150
Pediatric / Baby Blood Draw — $150
Specialty / Lab Kit Collection — $95
Additional Patient at the Same Location — $75 per additional patient
Specimen Pickup & Lab Drop-Off — $65
Therapeutic Phlebotomy — Starting at $150

Travel Policy

First 25 miles: Travel included in the listed service price.

Beyond 25 miles: Additional travel charges apply.

Travel charges will be calculated based on the collection location and disclosed to the client before the booking is confirmed.

Requests outside the regular service area are subject to availability and approval.

Important Pricing Notes

Same-day and STAT services are subject to availability.

Therapeutic phlebotomy starts at $150; the final price depends on the service requirements and acceptance criteria.

The additional-patient rate applies when multiple patients receive service at the same location during the same visit.

Laboratory testing fees are not included unless specifically stated in the written quote.

Specialty collections and lab kits must be reviewed to confirm collection, handling, and delivery requirements.

All appointments require confirmation by North Sound Mobile Phlebotomy LLC.