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Purchase History

Purchase Historydvgulik2021-10-11T01:40:53+00:00

26497 Rancho Parkway South
Lake Forest, CA 92630

info@inspirediagnostics.com

Phone: 949-868-4100

Coming Soon

Inspire Labs@Home comes to you and performs lab services in the comfort and convenience of your home, with no added costs. Contact us below for more information.

Name of Facility/Organization*

Estimated Number of Residents in your Facility*

Type of Facility*

Assisted Living / Nursing Home

Senior Services

Residential Community

Physicians Group

Other

Type of Facility - Other*

All Medicare Eligible?*

Yes

No

Other

Type of Facility - Other*

Frequency of Service*

Once per week

Twice per week

Three or more times per week

Other

Type of Facility - Other*

Will you provide a dedicated space for onsite draws?*

Yes

No

Other

Type of Facility - Other*

Point of Contact Name*

First Last

Title/Position*

Direct Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Facility Address*

Street Address Address Line 2 City State ZIP Code

Current Lab Provider (if any):*

Type "None" if you do not have a lab provider

How are your lab orders processed?*

Phone

Fax

Email

Other

Type of Facility - Other*

Do you have interest in other health and wellness services?*

Yes

No

Please share any other information

Target Start Date

MM slash DD slash YYYY

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Our mission is to open a world of possibilities to our customers, by providing the most advanced, affordable, and hassle-free, at-home diagnostic testing platforms.