Patient Request for Laboratory Test Results

Name: Patient Request for Laboratory Test Results
SKU: PTRSLT1
Availability: InStock

For your convenience Primex Clinical Laboratories offers the ability to securely submit your request for patient results online. Please enter the details of the patient results you would like to request. To proceed with your request, we must receive a copy of a valid government issued identification that is not expired and clearly legible. Any missing information may result in delayed or non receipt of your results. Please allow up to 14 business days to process your request. Results will be mailed to the physical address provided.

Bill Amount Due ( $ )

Patient Claim Information

Patient First Name *

Patient Last Name *

Date of Birth (DOB) – Use “MM-DD-YYYY” *

Date of Service – Use “MM-DD-YYYY” *

Referring Physician Name *

Patient Email

Mailing Address

E.g. “123 Main St, City, State, Zip” *

Additional Comments

Terms and Conditions *

Laboratory test results are only available to the patient or a personal representative who has authority under applicable law to make healthcare decisions for the individual. Any person advocating as a personal representative will be required to provide documentation.

The laboratory will not provide interpretation of any test results. For any questions pertaining to your results please contact your healthcare provider.

Submit Valid Government Issued ID

Upload a clear valid image of your ID *

(max file size 50 MB)

SKU: PTRSLT1 Category: For Patients