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Agkura® Personal Score Order Confirmation

Thank you, your order has been placed! An email confirmation has been sent to you.

You will also notice that you now have “Patient Portal Links” to the right. When you visit our site and login, they will automatically appear. You can click on them anytime to review your order(s), tracking, test results and other administrative tasks.

A Sample Collection Kit will be sent to you shortly. Once sent, you will receive an email with your tracking number. You can also view your tracking by clicking on the “My Account” link to the right.

Estimated delivery: 3-7 business days via UPS

Please proceed to the next step below.

Laboratory Requisition for Agkura® Personal Score

ordering steps 2

Next step is to download this form and print then fill out or you can enter your info below then click on the print icon at the end of the form.

Once completed, take the form to your doctor and have them complete the rest.

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13230 Ballantyne Corporate Place, Unit# 904, Charlotte NC 28277
www.oncotab.com; Email: customerservice@oncotab.com; Call: 1-855-ONCOTAB

Requisition for AgkuraTM Personal Score
Enzyme Immunoassay for tMUC1
(CLIA ID # 34D2103014)

Please complete ALL fields on this form

    Patient Information

    Last Name

    First Name

    Middle Name

    Address

    City

    State

    Zip

    Telephone

    Email

    Date of Birth

    Gender

    Height: (ft./inch.)

    Weight: (lbs)

    Order Number (check email receipt)

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