Test Requisitions
To request printed test requisitions, please contact an Labcorp Oncology representative:
Brentwood/Phoenix Clients call 866-875-2271
Shelton/New York Clients call 800-447-5816
The following test requisition forms have fillable fields, so you can download, save your client information and just add the patient information and test request(s).
Test Requisition Instructions
Complete the test requisition with all requested information. Ensure all required fields are filled out and information submitted is accurate.
- Client: account #, name, department, address, ordering physician, phone #, physician/authorized signature
- Patient: name, gender, DOB, address
- Billing: insurance company name, policy #, group # (attach face sheet and copy of insurance card)
- Specimen: hospital status when sample collected, specimen ID #s, body site, collection date and time
- Clinical: ICD-CM, clinical indication (attach clinical history and pathology reports), clinical status
- Tests/Services: select tests to be performed
Send a signed, printed copy of the test requisition with your specimens. Please ensure that all information on the test requisition matches the information on the specimens sent (i.e. blocks, slides, tubes).