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Test Kit Order Form
 
To be tested for the obesity virus, Ad-36, please read the instructions and information at the bottom of the page, fill out and submit the form below.

Fields in red are required

Name:    
Street or PO Box:    
City/State/Zip:  
 
Method of Notification: Please tell us how you would like to receive the test results:
Mail to Home
Fax to: 
Email to: 
 
If you would like us to send the result to your physician, please fill in the information below:
Physician Name:  
Physician Address:  
Physician Phone:  
Physician Email:  
 
If you plan to have your blood drawn at your local hospital, please fill in the name and city below:
Hospital Name:  
Hospital Street:  
Hospital City/State:  
 
Costs:: The cost of the test is $450, which includes the test, shipping and handling to you and the return overnight shipping back to us. A credit card is required for online orders.

INSTRUCTIONS:
Important! Please read!
1. Fill in the form above completely & click the "Submit" button below.
2. You must then call us at 1-804-344-5360 or email us at obetech@obesityvirus.com to arrange for payment of your fees.
3. In about one week you should receive a kit in the mail that will contain a Styrofoam container, a small freezer bag, a red top tube for your blood sample, a laboratory test order form, a Federal Express label to ship the sample to Obetech, and a plastic bag in which the sample must be shipped. Please do not lose any of these parts.
4. Take the kit to your physician or to a local hospital to have them draw your blood. It is best if you do not eat for 10 hours before the sample is drawn.
5. Ask your physician or hospital lab to return the sample to Obetech, LLC, using the Federal Express shipping form that is enclosed.
6. Once we receive the blood sample, it will take about 14 days to process the sample and run the assay. We will then send you the results by the method you indicated above.
 
INFORMATION:
1. You may cancel the test by notifying Obetech by phone, fax, or email, and a credit card credit will be forwarded to you if your test has not already been run. There is a $75 cancellation charge that will be deducted from your deposit. If the test has been run, you may not cancel.
2. Obetech is interested in additional information on obesity viruses that may be obtained from your blood sample. For example, we may run tests for antibodies to other viruses that we find in the future to cause obesity. Also, we may run assays for blood fats or certain hormones to determine their relationship with Ad-36. If you are willing to grant us permission to use your blood for other purposes, check the box below. Your sample will be assigned a number and all identification removed so you cannot be identified. You do not have to give us permission and if you do not, we will destroy your blood sample once the test has been performed. For further information, you may contact us at 1-804-344-5360 or email us at obetech@obesityvirus.com.
 

 
 
Note: By pressing "Submit", your information will be submitted to us. You must call us to arrange for payment for the Obesity Virus test fees.
 
 

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