SML Specimen Pickup Form

SML Specimen Pickup Form

Request a Specimen Pickup

For STAT pickups, please contact Client Services.
Account Name*
Account Number*
Pickup Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requestor's Name*

First NameLast Name
Email*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Select your region*

Mid-AtlanticMidwestNew York
Specimen Type*

RefrigeratedFrozenRoutine
Lockbox Details
Does this location have a lockbox?*

YesNo
If no lockbox, office closes at what time?

Hour : Minutes

AM/PM Option
If yes, lockbox available until what time?

Hour : Minutes

AM/PM Option
Additional Information
Special Requests
(needs cold packs, results, etc.)
Time specimen will be ready*

Hour : Minutes

AM/PM Option
Security Check*
Should be Empty: