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Laboratory Testing Services Customer Agreement Complete and Fax to: 805.426.8115 I. Customer Information Date: Customer Email: Facility Name: Ship To Address Bill To Address: Street: City×State×Zip:
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Nichols Institute is a company that provides medical testing services.
Healthcare providers who use Nichols Institute for medical testing services are required to file.
Nichols Institute forms can be filled out online or submitted through the mail.
The purpose of Nichols Institute is to provide accurate and reliable medical testing services.
The name of the healthcare provider, the type of medical testing services used, and any relevant patient information must be reported on Nichols Institute forms.
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