Location Update for Laboratory Services

This form is for lab clients  to update information for results routing and courier services. If you have any questions, please contact your lab services account manager.

*Indicates required information

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 – 4 pm, excluding holidays. You will be contacted within 1 – 3 business days.

    Your Name*:
    Your Role*:
    Your Email*:
    Office Full Name*:

    Current Office Information (Closing Location)
    Office Address*:
    Office Phone Number*:

    Office is*: Closing PermanentlyClosing TemporarilyMoving to a New Location

    Office Close Date*:

    Office reopen information
    Office Address*:
    Office Phone Number*:
    Office SECURE Fax Number*:

    Office Open Date*:

    Office requires courier pick up*:YesNo
    Pick ups are*: Routine (Scheduled)On Call (Must call for pick up)None or N/A
    Office Has a lockboxNeeds a lockboxNeeds to return a lockboxNo lockbox
    Lockbox type*: No lockboxOver the door lockboxWall mounted lockboxFloor lockboxOther

    For closing locations or cancellation of services
    Cancel courier services permanently YesNo
    Office has supplies to return (lockbox, collection devices, tubes, other lab items to return) YesNo

    For provider updates, please contact Corewell Health's Medical Staff Office or your Physician Relations Liaison.