Fake Pregnancy Document from 3 Weeks and Up - Customizable hCG Lab Report

Patient Name *

Please note: This exact name will appear on the document, including spacing and punctuation. Please double check the entered name.

Patient Date of Birth *

Please note: This exact date will appear on the document, including spacing and punctuation. Please double check the entered date.

Date Specimen Collected *

Tip: This is the date that the patient submitted their specimen to the lab. For an extra detail, add a time.

Date Specimen Entered *

Tip: This is the date that the lab entered the specimen into their system. This will typically be the same day or the next day from when the specimen was collected. For an extra detail, add a time.

Date Specimen Reported *

Tip: This is the date that the lab returned their results to the patient. This will typically be one or two days from when the specimen was entered. For an extra detail, add a time.

Ordering Physician *

Please note: This exact name will appear on the document, including spacing and punctuation. Please double check the entered name.

Lab Address Line 1 *

Lab Address Line 2 *

hCG Value *

Please enter a single number from the range indicated that represents how many weeks pregnant you want the Fake Pregnancy Document to report. Ex: 6 weeks pregnant - Enter any number between 1080 and 56500.