Testing Supplies

To request specimen collection kits or patient information brochures, please complete the form below or call 888.452.1522.

There is no cost to the provider / office to request testing supplies or patient education materials.

Download Test Requisition

Provider Name*
First Last
NPI Number*
Practice Name
Address*
Street Address City State Zip
Phone*
Primary office contact if not provider
Fax Number for Results*
Email
Number of AVISE Kits
Patient Information Brochures
- AVISE CTD (English) - SA1046
- AVISE CTD (Spanish) - SA1092
- AVISE SLE Monitor (English) - SA1718
- AVISE SLE Monitor (Spanish) - SA1172
- Lupus Foundation Brochure - Wondering if it's Lupus? (English) - SA1165
- Lupus Foundation Brochure - Wondering if it's Lupus? (Spanish) - SA1169
Brochures are shipped in packs of 50.
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Name
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