Fill out the Physician Directed Profile Form below. A copy will be automatically sent to Qitek Labs.

Prefer to fill out a paper copy? Click here.

Physician Directed Profile

  • Account Information

  • Physician Directed Profile

  • Qualitative/Presumptive Testing

  • Quantitative/Confirmation Testing

  • Physician Authorization

    I hereby authorize Qitek Labs to utilize the above panel as a custom Physician Directed Panel when performing any toxicology qualitative/quantitative testing for this account and location.
    • Date Format: MM slash DD slash YYYY