[The Center for Cholesterol Management] - Consultation | Dr Michael F Richman

Now there is an easy way for anyone throughout the US to enjoy the benefit of a consultation with America's foremost authority on cholesterol management, Dr. Michael Richman. Get a Go Kit that will enable you to have Dr. Richman's custom blood panel performed, including advanced lipoprotein testing, covered by all insurances including Medicare and Medicaid.

Called a "Go Kit", this test box will be sent to you. After paying your consultation fee of $300, you will be contacted by Dr Richman's office to set up your phone consultation to review the results of your blood work and get recommendations for treatment. In addition, you will be entitled to have a phone consultation with Dr Richman's nutritionist free of charge. Simply fill out this form and your kit will be sent to you directly.

The Go-Kit and the information sheet can be taken to a local blood draw station or your doctor's office to have your blood drawn for your unique diagnostic testing.

After the blood samples are drawn, simply follow the instructions in the box -- we do the rest. *Don't forget to include Dr Richman's requisition sheet (which will be delivered to you).*

**Note**
Requisitions are taken Monday through Friday 9AM to 5PM PDT. If you are submitting this form after 5PM on Friday, your requisition will be processed the following Monday.)

Patient Information

Full Legal Name:

First

Last

Date of Birth:

YYYY

Social Security Number:

Gender:

Female

Male

Height (if known):

Weight (if known):

lbs

Address:

Street

City

State

Zip

Phone:

Email:

Confirm Email:

Insurance Information

Insurance Provider Name:

Provider Full Name

Policy Number:

Group ID:

Member Number:

Person Insured:

Full Name

Insurance Company Phone:

(found on back of card)

Insurance Company Address:

Street

City

State

Zip