Deposit Only Option

Fill out this registration form. After you submit, the site will take you to the payment page where you will pay for the deposit. In order reserve your seat you MUST pay your deposit which is NON REFUNDABLE. The remaining balance is due first day of class.

First name

Last name

Phone number

Birthday

Month

Day

Year

Address

Can you present a valid ID?

Can you provide a Highschool Transcript, GED, or Diploma?

Do you have a criminal record?

Course Date

Non Refundable Deposits

$250

Deposits cover: books, supplies, and your exam. REMAINING BALANCE ($650) IS DUE FIRST DAY OF CLASS

After you submit this form, you will be directed to pay. Once paid you will receive an email with the Catalog and Enrollment Agreement to sign electronically. Once payment is received, you will be officially accepted into P&M Gentle Hands Phlebotomy Academy and will receive your Letter of Acceptance, study materials, and instructional videos so you can begin the same day. Access to the National Exam

I understand once I sign I am aware and have acknowledge the information above is accurate

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