Secure order request

Send collection details to Copper Med.

Use this form for DOT or non-DOT orders. Do not enter patient medical information here — the patient completes their own private intake. After submission you receive a private intake link to send directly to the patient or donor.

Already order through FormFox? Place your order on FormFox and select Copper Med Long Beach as the collection site.

Choose a testing option

Per-person checkout. Secure Square checkout follows submission.

Outside-lab results are provided by the laboratory and will not appear in the Copper Med portal.

Collection order

Organization

Contact email or phone

Confirmation email (optional)

Patient mobile phone

Used to prepare the scheduling and private intake text message.

Requester / lab

Order or requisition number

Test type

Testing reason

Order and collection directions

Choose your appointment time

Pick a date and time. We'll confirm it by phone or text.

Appointment date

Appointment time

Backup time if taken (optional)

Best way to confirm

Special requests or notes (optional)

0/1000

I agree that payments are final and nonrefundable. Appointments cannot be canceled; I must call Copper Med to reschedule, and only one reschedule is allowed.

Selected checkout

Rapid POCT · 5-panel

$45.00

Staff test code (book without payment)

Need monthly Net-30 or invoicing? Apply for a business account (minimum 50 customers/month).