PATIENT AUTHENTICATION FORM (WEBSITE)

Lab Test Results Support Form
This is an encrypted form that is sent securely to Biotech Clinical Laboratories to help resolve your issue of not being able to download your laboratory test results. Please note, it is possible your report is not yet available, due to it being in a "Partial Status". Final Reports are only released to the portal.

Please allow up to 1-2 business days to receive a response to this form.

If your report is found, you will receive an e-mail with instructions on how to access your lab report via the separate encrypted email. Please be sure to check your spam/junk folders if you do not receive a response to this form.

PLEASE DO NOT SUBMIT MULTIPLE FORMS.
Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
Your Date of Birth
Date of Labs Drawn:*

MonthDayYear
Date your specimen was drawn
Your Doctor / Office where your labs were drawn:*
E-mail (Encrypted)Paper via Mail
Send to (name):
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address:*

Confirmation Emailexample@example.com
Additional Information:
Submission Date/Time:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty: