Order Test

Order TestAli2020-09-01T23:08:24+00:00

1 Insurance

2 Your Info

3 Shipping

4 Payment

Please select one of the following*
- I am self-pay
- I have a Groupon voucher
- I have a coupon code
ColonCancerScreeningKit.com is in network with Blue Cross Blue Shield. We will verify eligibility and ship your kit.
Member Name*
Member ID*
Group Number*
Please enter your Groupon voucher to redeem.
Groupon Voucher #
Coupon Code
FIT Kit
Price: $35.00
Total
$0.00

PATIENT INFORMATION
Name*
First Last
Date of birth*
Date Format: MM slash DD slash YYYY
Phone*
Email*
By clicking "Continue" you confirm and acknowledge that you have read, understood and agree to be bound by the Privacy Statement and Terms & Conditions.

SHIPPING ADDRESS
Shipping Address*
Kits are mailed via United States Postal Service. Only enter an address deliverable by USPS.

Street Address Address Line 2 City State Zip Code

PAYMENT INFORMATION
Total
$0.00
Billing Address
Same as shipping

Street Address Address Line 2 City State Zip Code
Credit Card*

Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Order Summary

Colon Cancer Test Kit
Qty: 1

$35.00

Subtotal

Shipping

Free

Total