Pick Up Request Form

Pick Up Request Form | Cincinnati

Starting Nov 3, 2025, Industry Lab is moving to the UPS Placard Program for faster, more reliable healthcare sample pickups. Form Questions? Contact your sales rep, call 513-866-7922, email upspickup@ildp.com, or fill out this link: https://form.jotform.com/252655753787069
Facility Name*
Facility Address*
Location of sample(s)*
Patient Initials *
Submitted by:*

First NameLast Name
Email for Submission Confirmation*
example@example.com
Date of Request*

MonthDayYear
Date
Should be Empty:

Pick Up Request Form | Cincinnati