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WELCOME TO DREAMCARE

בס"ד

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Patients First name

Patients Last name

Test Requested*

155 NIS CBC

345 NIS Gen Chem 2: (Fast required, water is allowed) ALB TP GLOB A/G ALP GGT ALT AST TBIL UA UREA CRE AMY GLU CHOL TG HDL-C LDL-C

345 NIS Electrolyte & Renal Panel: K+ Na+ Cl- Ca Mg2+ P Co2 CRE UA UREA

345 NIS Clinical Emergency Panel: AST GLU AMY K+ Na+ Cl- Co2 CRE UA UREA CPK CK-MB LDH (lactic dehydrogenase) a-HBDH

136 NIS Urinalysis

350 NIS hsCRP

285 NIS Troponin - AMI cTnI

385 NIS D-Dimer

310 NIS B-HCG

190 NIS Ha1c

210 NIS TSH

340 NIS FT3

210 NIS FT4

394 NIS NT-proBNP

250 NIS Vitamin B12

395 NIS Vitamin D

290 NIS Testosterone

290 NIS Ferritin

410 NIS hGH Human Growth Hormone

190 NIS INR

**NEW** All prices are now including VAT %18

Patients Email

Patients phone number

Requesting Doctor (If applicable)

Doctors Email

Doctors Phone Number

Patients DOB

Month

Day

Year

Patients Age

Teudat Zehut or Passport

TZ or Passport

Kupa?

Patients Address

Please make sure to include Street address, Knisa, Floor, Apt number

URGENT?

Dream Care Clinic or Home Visit?

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