NEW PATIENTS Current patients Submit your Lab Results Get Labs Rev 9/17/23 Step 1 of 2 50% HiddenDate MM slash DD slash YYYY Viking offers discounted lab assessments for therapy candidacy and health optimization. Please note the following regarding lab work: Current blood work within the last 6 months is required. If your lab results are older than 6 months, consider these options: Lab work does not have to be purchased through Viking. You can use lab work from your primary care physician, different lab facilities, or other providers within the last 6 months. "At home Blood testing kits" are not accepted by the medical staff at Viking. To order a lab requisition or seek assistance, please provide the necessary information by answering the following questions.What is your gender?(Required) Male Female What State do you live in?Please start typing your stateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific This is an order form for a Lab Requisition for Blood Analysis, necessary for assessing your physical condition and eligibility for Hormone Replacement Therapy. It also helps in prescribing the appropriate therapy protocol. No payment is required currently. To order, indicate your desired panel by entering "1" in the quantity box and submit the form. For direct insurance billing instead of a prepaid requisition from Viking, please choose "I would like to submit to my own Health Insurance", below. We will ensure all necessary information is included. A Patient Representative will reach out to you at the provided phone number or email to review and finalize your order.Which type of Lab Requisition you would like? Viking Prepaid Lab Requisition Viking Lab Requisition to submit to my own Health Insurance Before visiting the lab, confirm coverage, deductibles, and any potential lab fees with your insurance plan to avoid surprises.Male Panel. SUBMIT TO YOUR INSURANCE Quantity Price: $0.00 Quantity Includes: Total Testosterone Complete Blood Count Comprehensive Metabolic Panel Estradiol PSA Lipid Panel TSH Female Panel - SUBMIT TO YOUR INSURANCE Quantity Price: $0.00 Quantity Includes: Total Testosterone Complete Blood Count Comprehensive Metabolic Panel Estradiol Progesterone Lipid Panel TSH Male LabCorp Panel Quantity Price: $125.00 Quantity Includes: Total Testosterone Complete Blood Count Comprehensive Metabolic Panel Estradiol PSA Lipid Panel TSH Male Quest Diagnostic Panel Quantity Price: $125.00 Quantity Includes: Total Testosterone Complete Blood Count Comprehensive Metabolic Panel Estradiol PSA Lipid Panel TSH Male Quest Diagnostic Panel Quantity Price: $225.00 Quantity Includes: Total Testosterone Complete Blood Count Comprehensive Metabolic Panel Estradiol PSA Lipid Panel TSH Female LabCorp Panel Quantity Price: $125.00 Quantity Includes: Total Testosterone Complete Blood Count Comprehensive Metabolic Panel Estradiol Progesterone Lipid Panel TSH Female Quest Diagnostic Panel Quantity Price: $125.00 Quantity Includes: Total Testosterone Complete Blood Count Comprehensive Metabolic Panel Estradiol Progesterone Lipid Panel TSH Female Quest Diagnostic Panel Quantity Price: $225.00 Quantity Includes: Total Testosterone Complete Blood CountComprehensive Metabolic PanelEstradiolProgesteroneLipid PanelTSHFor our Alabama Residents:We are sorry but due to regulatory issues, Viking cannot provide services to the residents of Alabama or Mississippi at this time. Please leave your contact information in the form below and we will notify you when we can accept Alabama residents in our program.For our Mississippi Residents:We are sorry but due to regulatory issues, Viking cannot provide services to the residents of Mississippi at this time. Please leave your contact information in the form below and we will notify you when we can accept Mississippi residents in our program. For our New York ResidentsPlease call the Vikiing Office at (210) 826-8900 to review the available options for obtaining your lab requisition and subsequent lab work.Total Email(Required) Phone(Required)Date of Birth MM slash DD slash YYYY Name(Required) First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Any Questions? Please include them here.A Viking Representative will contact you to review the requisition and to verify payment, if necessary.