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Patient Intake Form

Welcome to iollo! Our blood test analyzes 500+ biomarkers to provide deep insights into your patient's health and create personalized recommendations.

To get started:

1. Complete this form.

2. Choose how to provide your patient with a kit:

- Directly at your office, or

- Shipped to their home.

3. You will be billed directly once we process your patient's sample.

Thank you for choosing iollo. We're excited to help your patient achieve better health!

What's your patient's name?

What's your patient's email?

What's your patient's phone number?

What's your patient's date of birth?

How would you like to provide a kit to your patient? If you select 'In-Person at the Office' please provide your patient with a kit directly. On the next step, you'll be asked to choose whether you will collect your patient's sample at the office or your patient will self-collect their sample at home. If you select 'Home Delivery/Drop-shipping', we'll send your patient a kit directly to their home, free of charge, within 2-3 business days.

Future kits will be automatically shipped to your home address.

A

In-Person at the Office

B

Home Delivery/Drop-shipping