Shiphrah Birth Services Lab Day Sign-Up Question Title * 1. First and Last Name Question Title * 2. Email Address Question Title * 3. Phone Number Question Title * 4. Date of Birth Question Title * 5. Which labs do you want drawn? CBC w/diff & Ferritin: $25 Vitamin D: $25 Lipid Panel: $10 Comprehensive Metabolic Panel: $10 Hemoglobin A1C: $25 Thyroid Panel: $125 (Incl. T3 Uptake, T4 Total, Free T4 Index, TSH, Reverse T3, Thyroglobulin Antibodies, Thyroid Peroxidase) All of the Above: $200 Other (please specify) Question Title * 6. What is your preferred time? 9 a.m. 9:15 a.m. 9:30 a.m. 9:45 a.m. 10 a.m. 10:15 a.m. 10:30 a.m. 10:45 a.m. 11 a.m. 11:15 a.m. 11:30 a.m. 11:45 a.m. Done