Test Form Tick Information Instructions: Complete a separate form for each Universal Tick Test. If submitting multiple ticks for individual testing, fill out and submit a new form for each tick.Unique specimen name*Write this name/label on each bag. If submitting two ticks from the same host, clearly indicate this. Date of tick bite* MM slash DD slash YYYY Do You Know the Zip Code of your Tick Encounter?*Multiple ticks with different locations? Enter most recent location. Yes No State of tick encounter*Please SelectPlease SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCounty of tick encounter*Enter zip code*The tick was found on*Please Choose OneHumanDogCatIndoors (loose)Outdoors (loose)OtherGender of host?*Please Choose OneMaleFemaleNot SureAge of Host*Please Choose One0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+not sureHow did you hear about us?* Physician or Clinic Ai Search Tool Google/Bing Social Media Other Terms & Conditions Ticknology’s tick tests provide a truthful assessment of tick infection status and can be used in determining the risk of exposure to a tick-borne pathogen. Our tests utilize a proven highly specific and sensitive method for detecting the presence or absence of DNA associated with the specific pathogens advertised. However, our tests are not to be used as a substitute for clinical testing. Tick tests do not provide clinical diagnosis of disease and we do not practice medicine nor do we provide medical advice. Importantly, it is encouraged that results are shared with a physician during a consultation. Results from your tick test are kept private and individuals submitting ticks remain completely anonymous. Information about the submitter is used only for the purpose of processing the sample, handling the payment and communicating with Ticknology, LLC. Tick tests are not typically covered by medical insurance, even though our consultants and possibly your physician may advocate having the tick analyzed for risk of infection.Click here to indicate that you have read and agree to the terms presented in the Terms and Conditions agreement* Yes Universal Tick Test* Price: Service OptionsLaboratory Processing*Standard 3 - 5 DaysPriority 24 - 72 hoursBartonella Testing*IncludedTotal price for each testTotal cost will be reflected on the Checkout Page $0.00 CAPTCHAURLThis field is for validation purposes and should be left unchanged.
