Request Forms

It is essential that the following criteria are fulfilled when completing a sample request form in order for us to accept the sample and to avoid delays caused by discrepancies - 

• Complete the request form fully
• Please use addressographs where possible
• Please print clearly making sure to state

• Hospital name and name of clinician
• Full patient name or unique code identifier (clearly indicating which name is the forename and surname)
• Date of birth
• Hospital number
• Specimen or sample type
• Relevant clinical information

Please clearly indicate on the request form (and accompanying dispatch log) if a sample is urgent, along with information of how the clinician is to be contacted with the result and the date the report is required.

Please indicate clearly on the request form if a specimen is or suspected to be high risk.