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General Request Form

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Histology Request Form

Laboratory Requisition Notes:

The requisition undergoes periodic review and updating to include evolving laboratory protocols and ordering rules.

Please complete all demographic fields on the requisition to meet our minimum requirements to ensure positive patient identification:

  • Patient name
  • Patient Date of Birth & Gender: Many tests use age and/or gender to provide the appropriate reference ranges on the report
  • Physicians Name and Contact info: It is important to the laboratory in the event that the physician must be contacted regarding unexpected critical laboratory findings

Use tick boxes to select tests as available. Ensure the tick mark (or x) is easily viewable.

It is important that all fields entered in text are legible. Time taken by laboratory staff to verify a test request interrupts your office and increases wait time for our patients

  • Opening Hours

    • Monday - Friday : 8:00am - 4:00pm
    • Saturday : 8:00am - 12 noon
    House calls by appointment
  • Get In Touch With Us!

    Please use any of the contact information below to submit your questions. We'll be happy to answer any of your concerns.