Request a Specimen Pickup
For STAT pickups, please contact Client Services.
Account Name
*
Account Number
*
Pickup Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Requestor's Name
*
First Name
Last Name
Email
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Select your region
*
Mid-Atlantic
Midwest
New York
Specimen Type
*
Refrigerated
Frozen
Routine
Lockbox Details
Does this location have a lockbox?
*
Yes
No
If no lockbox, office closes at what time?
Hour : Minutes
AM
PM
AM/PM Option
If yes, lockbox available until what time?
Hour : Minutes
AM
PM
AM/PM Option
Additional Information
Special Requests
(needs cold packs, results, etc.)
Time specimen will be ready
*
Hour : Minutes
AM
PM
AM/PM Option
Security Check
*
Submit
Should be Empty: