Order Test Kits All orders will be securely billed to your credit card via Stripe. The test result timeline will vary based on the test ordered. NameThis field is for validation purposes and should be left unchanged.Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Male Female Address(Required) Street Address Apartment Number, Suite Number, Building Number, etc. City ZIP Code State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificEmail(Required) Phone(Required)How did you hear about us?(Required)Physician ReferralReferring DentistVirtual hygienistOnline or InternetWord of mouthName of referral source?Product NameAvailable Tests MOST PREFERRED: Saliva Analysis for Harmful Bacteria, Yeast, and Viruses in Mouth Biofilm with Basic Interpretation Saliva Analysis for Oral Yeast Saliva Analysis for HPV Genetic Testing for Gum Disease Susceptibility Available Tests (NY residents) For Saliva Analysis for Harmful Bacteria in Mouth Biofilm (New York Residents) Other Available Tests Pre-Recorded 15-Minute Interpretation Live 30-Minute Consultation Have you been on antibiotics in the last five weeks?(Required) Yes No Have you had your teeth cleaned in the last five weeks?(Required) Yes No If you answer yes to any of the above: DO NOT PROCEED! Please email support@homedentalexam.com with your contact information and we will contact you to discuss a preferred date for testing.Coupon Subtotal $0.00 Tax $0.00 Total Credit Card(Required)Card Details Cardholder Name Consent(Required) I give permission to Dr. Doug Thompson to have access to my report.Physician Consent(Required) I do give Dr. Doug Thompson permission to share my test results with my physician. I do not give Dr. Doug Thompson permission to share my test results with my physician.
