FOR PHYSICIAN USE ONLY. Testing is not yet available in New York state.

Please contact us at 919-313-9672 x223 or contact@galaxydx.com, if you have questions.

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  • Galaxy Diagnostics Kit Order Form

  • Physician Account Information

  • Kits Requested

    Please limit your first order to 20 kits total.
  • Please enter a value between 1 and 20.
    Includes forms, shipping materials, and supplies for a single blood draw: 1 EDTA tube (purple top) and 1 SST tube (yellow top).
  • Please enter a value between 1 and 20.
    Includes forms, shipping materials, and supplies for a triple blood draw for one patient: 3 EDTA tubes (purple top) and 3 SST tubes (yellow top).
  • Please enter a value between 1 and 20.
    Includes forms, shipping materials, and supplies for tissue, CSF, joint fluid, effusions, etc.
  • Please enter a value between 1 and 20.
  • Shipping Information

    If different from the Physician Account Information
    Our standard delivery is within 3-5 business days. Please select your choice(s) below.
  • This field is for validation purposes and should be left unchanged.