Lab Request

Your Name (required)

Office Name (required)

Phone Number (required)

Secondary Phone Number (optional)

Your Email (optional)


Request (In accordance with HIPAA, do not include Patient Health Information)

Note: This is not a secure form. Please do not use this online form to send health information about a patient. For more information review our Patient Privacy Policy.

If you need to discuss private or sensitive patient information, or for specimen pickups, add-on test and urgent requests please contact 616.774.7721.

This email is monitored Monday – Friday 9 am – 5 pm. You will be contacted within 1 – 3 business days.