PLEASE NOTE:
Industry Lab has fully transitioned to UPS for all pickups. If you have any questions or need help with the process, please reach out to your sales representative or email upspickup@ildp.com for further instructions. Thank you!
Facility Name
*
Facility Address
*
Location of sample(s)
*
Patient Initials
*
Submitted by:
*
First Name
Last Name
Email for Submission Confirmation
*
example@example.com
Date of Request
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: