Patients, if you would like to take the EXA test

• the specimen must be collected by a healthcare professional (doctor, nurse, etc.). 

Therefore, You may

• Provide your physician's contact information below, and we will ship an order to him/her on your behalf, or
• If you do not have a physician, you may request a list of physicians in your area 

Please provide the following contact information:

MD First Name
MD Last Name
MD Middle Initial
Degree/Description
Title
Clinic
Practice Specialty
MD Office Phone
MD FAX
MD E-mail
MD URL
Patient First Name
Patient Last Name
Patient E-mail/Tel.
Patient Zip Code

You may order the items below for your MD at no cost to physicians in the USA.

         Please select order:

                  Literature for my MD, (includes research)

                 I have an MD, please send Literature and

                     a Specimen Collection Kit: Starter kit of 10 slides. 

                 I do not have a physician, please send a list of doctors in my area

Enter additional messages below:

                 Please Contact Me

Healthcare Providers, CLICK HERE FOR YOUR ORDER OPTIONS