Dear Int'l customer, thanks for choosing the Payvand laboratory. This form is only designed for our International applicants, please carefully complete the information in Persian and English in capital letters in accordance with your national card and passport.
To be completed by the customer
I have read the relevant rules and regulations before submitting a sampling request
Note:
Your submitted date and time are indefinite and can be changed due to the availability of providing our In-home servicing. Our colleagues will announce the presence of our staff at your place after checking the confirmed date and time.
To book an appointment for sampling in-home, please deposit the amount of 100.000 Tomans (equivalent to 1.000.000 Rials) as prepayment to the card number 6037701157507234 in the name of Dr. Behzad Poopak , Keshavarzi Bank, and upload the image of your deposit on the location in the sampling request form.
Note: As the queuing is limited, in case of cancellation of your booking time, your prepayment amount (deposit) will not be refunded.
Clinical details
I confirm the information registered in this form and accept the terms and conditions of the requested service
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