Phlebotomy Lab Sign Up Form

Phlebotomy Lab Sign Up Form

Sign up to complete sticks OR to retake Final or Practical exams
Please fill out the form below and select a date/time that you would like to reserve.

You are allowed to bring in a volunteer to stick.

If you need to cancel your scheduled time, please do so no less than 24 hours prior to your reserved time. You can cancel by sending an email to sdyhall49@gmail.com.

If you schedule but do not show up or cancel 24 hours in advance, you will be charged a fee of $25 to be paid before you can reschedule. When you reserve a spot, you take that spot away from someone else who may want it. Do not sign up for a date/time unless you are reasonably sure that you can show up.

You should arrive in scrubs and make sure that you bring your stick log.
Full Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail:*
Number of remaining sticks needed*
Appointment for Sticks*
Appointment To Re- Take FINAL EXAM*
Appointment To Re- Take PRACTICAL EXAM*
Should be Empty: