Appointment Request

Book Your Appointment

Fill out the form below and we'll confirm your appointment within 24 hours.

We Come to You

In-home, workplace, or any convenient location.

Certified Phlebotomist

Licensed and experienced in all specimen types.

DOT & Non-DOT

Compliant drug testing for regulated industries.

Flexible Scheduling

Morning and afternoon appointments available.

Patient Information

First Name*

Last Name*

Email*

Phone*

Date of Birth*

Service Location

Street Address*

City*

State *

ZIP Code*

Appointment Details

Service Type *

Preferred Date *

October 2026

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Alternate Date (optional)

Clinical Information

Ordering Provider / Doctor

Lab Orders / Tests Requested

Upload Documents (lab orders, referrals, insurance — optional, max 5 files, 10MB each)

Click to upload or drag & drop

PDF, JPG, PNG, DOC, DOCX accepted

Special Instructions or Notes

How did you hear about us?

Please note: Submitting this form is a request only — your appointment is not confirmed until you receive a confirmation call or email from us. A valid laboratory order from an authorized healthcare provider is required for most specimen collections. Government-issued ID is required at the time of service. Testing is performed by a certified laboratory.

I have read and agree to the Phlebotomy Consent Terms. I understand that by submitting this form I consent to specimen collection services provided by Blessed Hands Mobile Phlebotomy Services.

You must agree to the consent terms before submitting your appointment request.

Secure Payment

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Pay online through our secure payment portal before or after your appointment.

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