Select the form that you need:
- Chain of Custody Request Form
Use this form to order tests that could be used in a court of law.
- Critical Values Notification
Use this form to define contacts for critical values notifications.
- Maternal Screening Material
Use this information and form to obtain certification for maternal screening.
- Patient Information and Signature Forms
Use these forms when a test requires additional information or signatures.
- Add Test to Order
Request additional tests after a specimen has been shipped.
- Test Setup Request
Generate a spreadsheet containing the setup information for multiple tests, and use the spreadsheet to build ordering codes and test (result) codes into your laboratory information system (LIS).
Manual Test Request Forms
If you order tests electronically through the MayoACCESS® or the MayoLINK® application, continue to order tests through those systems. If these applications are not available, use the following form:
If you order tests manually by submitting printed forms, use the following forms for specific tests.
- Allergen Test Request Form (T236)
- Benign Hematology Test Request Form (T755)
- Cardiovascular Test Request Form (T724)
- Coagulation Test Request Form (T753)
- Gastroenterology and Hepatology Test Request Form(T728)
- Hematopathology/Cytogenetics Test Request Form (T726)
- IHC/ISH Stains Request Form (T763)
- Inborn Errors of Metabolism Request Form (T798)
- Iothalamate Test Request Form
- Microbiology Test Request Form (T244)
- Neurology Test Request Form (T732)
- Oncology Test Request Form (T729)
- Pathology Test Request Form (T246)
- Pharmacogenomics Test Request Form (T797)
- Prostate Health Index (phi), Serum (T792)
- Whole Exome Sequencing Test Request Form (T801)
If none of those tests apply, use the General Test Request Form (T239)
After completing and printing, send the form with your specimens to Mayo Medical Laboratories.
Specialty Test Lists
Ordering physicians can use the following lists for communication with their sendout staff.
Note: These are not test request forms and should not be submitted with specimens.