SETUP YOUR SIBO TESTING ACCOUNT

To open an account for SIBO Testing (Quintron and/or trio-smart^®), simply fill out the form below, and we will respond within 2 business days to confirm your application.

You will also receive information on billing, shipping, and consultations with Dr. Khangura. If you would like to speak to us directly before opening an account, please feel free to Contact Us.

Please complete the form below

Physician name *First Name

LastName

Professional Designation *

If Other, Please Specify

License Number *

Other Health Care Providers Please list the other health care providers within the office that may use SIBO Diagnostics. This allows for each health care provider to receive confidential results reporting.

Clinic Name *

Clinic Address * Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Email Address

Clinic ContactPerson of contact at clinic, if not ordering physician. (i.e. Office Manager/Administrator)

To place your credit card on file, please download and send us the Credit Card Payment form below via email or fax (778-698-1926) in order to expedite your account setup.

Credit Card Payment Form