Online Payment
You have received this request for payment because your provider ordered a Tempus test to help inform your treatment plan. Please complete this form to pay online. If you have any questions or require any assistance, please let us know by emailing billing@tempus.com or calling 800-739-4137 Option 9.
Patient Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Please select the patient's date of birth
My Products
*
prev
next
( X )
Tempus Genetic Test - xF Panel
$
649.00
Quantity
0
1
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Patient Description
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
example@example.com
Submit
Should be Empty: