Work Request Form

  • Work Request Form

    Instructions: This form will take approximately 10-15 minutes to complete.

  • This form can be saved as a draft for completion/submission at a later time.

  • Are you a new or an existing client?

  • Requester's Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Is Shipping address same as Billing address?

  • Shipping Information

  • Specimens will be transported via

  • If needed, a shipping label will be requested at a later time.

  • Billing Information

  • Payment Method*
  • Purchase Order will be*

  • Specimen Information

  • Format of specimens being provided
  • "Wet" Tissue Samples Provided In
  • Will the tissue samples need to be trimmed in order to fit them in our standard-sized cassettes and molds?
  • Requested Services (check multiple)*
  • Section thickness
  • Is special sectioning needed? Eg. levels, or multiple sections per slide

  • Sample ID List

    You may list up to 20 samples ID and stains for each sample OR attach an Excel file.
  • Will you be providing the list of Sample IDs on this form or Excel file?
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: