Tidioute Annual Comprehensive Blood Testing

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Titusville Area Hospital (TAH) is pleased to offer comprehensive blood testing for heart disease, kidney disease, diabetes, anemia and liver disease. You must fast at least 12 hours prior to having your blood drawn.

Name *

Phone Number (this number will be used to contact you for completion of this registration) *

Address *

Family Physician /PCP *

Which blood test would you like? (check all that apply) *

Comprehensive blood testing - $40.00

Diabetes testing (A1C) an additional charge of $10.00

Thyroid function test an additional charge of $5.00

Required

What date and time would you like to have your blood drawn? (You must fast at least 12 hours prior to having your blood drawn.) *

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