ARE YOU INTERESTED TO BE A PART OF AUROPROBE COLLECTION NETWORK ?

If yes, please fill the form and send it to:
Co-ordinator, Collection Centre Network, Auroprobe Laboratories

* are mandatory

APPLICATION FORM FOR OPENING AUROPROBE COLLECTION CENTRE

Name*
Address*
Pin
Phone*		Fax
Email
Are you a Doctor by Profession	Yes No
If yes, please mention your profile	MD Yes No
If yes, please mention your specialisation
Do you have a Pathology Lab/Diagnostic Centre	Yes No
If yes, please mention the address
Place where you want to open Collection Centre
Status of Infrastructure you have (please tick)
Space Room-150 Sqr Ft Bathroom-40 Sqr. Ft. Air Conditioner Telephone Inverter With Battery (For two lights and fan) Reception Counter   Centrifuge For Serum Separation Phlebotomy Chair   165 Litre Refrigerator Seating For 5 People   Needle Disposer Mobile Surgical Screen   Multimedia Computer With Printer One Stainless Steel Trolly   Fax Machine
How many samples you are expected to send to Auroprobe Laboratories in a month
TB-PCR PCR for Hepatitis RAPID AFB Culture Others PCR Assays