If you are not ready to sign up, but would still like more information,
To sign up for an account, please fill out the provider agreement below. A copy will be emailed to you for your records.
For a printable version, please click here.
1 Practice Information
2 Primary Practitioner(s)
Please note: Labrix requires that all providers who sign up for a testing account verify that they are allowed to order testing based on the requirements of the state in which they are licensed. Holistic practitioners, nutritionists and health coaches MUST provide the name, designation and license number for a practitioner licensed to order testing. Provide these details in the additional contacts below.
4 Other Information
Your results will be available online in PDF format. This option requires a valid email address, which will be used
as your username as well as receive notifications when new reports are available. Upon registration, you will receive
an email containing a temporary password.
5 How many kits would you like Labrix to send you?
Test kits are always free.
Labrix only charges for completed testing. Once your account is set up, you will receive a price list for Labrix tests and panels.
Minimum of 3 kits per order (kit order can be a mix of different kit types).
Prepaid shipping is available only within the United States and Canada, additional shipping charges may apply.
Unfortunately, NY providers are not able to test NTs or DNA at this time.
Providers outside of the US must choose Professional Pricing.
Clear 'Country' above to allow Labrix Collect.
NY, NJ, RI providers must select Labrix Collection.
Labrix Billing Terms and Conditions
Professional Pricing: Receive the wholesale, professional pricing and collect payment from your patient
(refer to your state regulations). Billing is run monthly for the number of tests that
have been performed for your clinic. All billing is charged to the credit card stored on file.
Not available in New York, New Jersey, or Rhode Island.
(Please note that each individual hormone or cortisol level is considered a test.
Thus, 4-sex hormones and 4 cortisols equal 8 tests.)
Labrix Collection: Labrix will handle all aspects of fee collection including insurance
billing (if applicable); patients pay Labrix directly. The fee collection information is provided with each kit.
Required for New York, New Jersey and Rhode Island accounts.
Labrix Collection is only available in the United States
For patients billing Medicare: If you are enrolled in Medicare and the testing falls within
your scope of practice, Labrix can bill Medicare for your patients' hormone and neurotransmitter testing.
If, for any reason, Medicare denies the charges, you will be responsible for payment.
Credit Card Information
Policies and Signature
I have read and fully understand my responsibility for the billing option chosen. If Professional Pricing is selected, I understand that I will be charged according to the current Professional Price and I agree to comply with the following: Charges will be billed to my account once per calendar month, and I agree to pay all outstanding balances upon receipt of invoice. I understand that unpaid balances over 30 days old are subject to an interest charge of 9% (APR.) If payment is not received on this account within 68 days from date of invoice, Labrix will turn the overdue balance to a Collection Agency. Practitioners in NY, NJ, and RI may not send payments or have charges billed to their account. In these states, financial transactions may only be made directly with patients. Professional Price is mandatory for all accounts outside the US. If Labrix Collect is chosen, I understand that Labrix will never bill the Provider for patient testing and is the required billing option for NY, NJ and RI. Patients will submit payment to Labrix in their test kits or request that Labrix submit a claim to their insurance company. I acknowledge my responsibility for understanding and abiding by any federal or state laws that may regulate my ordering of testing for others.
Medicare-enrolled Providers: Labrix will bill Medicare for testing if you are enrolled in Medicare and the testing falls within your scope of practice. It is up to Medicare to make the ultimate decision on coverage. Due to recent restrictions on Medicare coverage, it is unlikely that Medicare will cover all of the testing ordered, specifically, salivary hormone testing. Please refer to the Advance Beneficiary Notice (ABN) that will be included with the Medicare Patient Pay Form to determine potential coverage.
Please note: Labrix Clinical Services has recently merged with Doctor’s Data and is now able to offer you a more comprehensive test menu. When your Labrix account is fully established and active, a Doctor’s Data account will also be created for you, with no additional forms required. Learn more about Doctor’s Data here: www.doctorsdata.com.
By entering your name below, you are agreeing that you have read and accept the
Doctor's Data/Labrix billing policies.