Clinical Laboratory Test Request Form

Clinical Laboratory Test Request Form Template

Healthcare providers need a streamlined way to order laboratory tests, submit accurate patient information, and coordinate specimen collection and results delivery. This Clinical Laboratory Test Request Form gives medical practices, clinics, and hospitals a professional solution for managing diagnostic test orders from start to finish.

Who this form is for

This template is ideal for physicians, nurse practitioners, medical assistants, hospital administrators, and clinical laboratory staff who need to coordinate diagnostic testing. Whether you're running a private practice, urgent care clinic, hospital department, or specialty medical facility, this form ensures every test request includes the essential information for accurate processing and billing.

What makes this form effective

Built with Paperform's intuitive doc-style editor, this form captures test type selection, complete patient demographics, insurance and billing details, specimen collection instructions, and results delivery preferences—all in one streamlined workflow. Conditional logic shows relevant fields based on test type and insurance status, reducing form length and preventing errors.

The form includes structured sections for patient identification, ordering provider information, insurance verification, test panel selection, clinical indication, specimen details, and delivery method—ensuring labs receive everything needed for smooth processing without back-and-forth calls and faxes.

Automate your laboratory workflow

Connect this form to your broader healthcare operations using Stepper, Paperform's AI-native workflow automation platform. Route test requests to the appropriate lab departments, send confirmation emails to patients and providers, update your laboratory information system (LIS), trigger insurance verification processes, and notify staff when stat or urgent tests are ordered.

You can also integrate with your practice management system, EHR, or CRM to keep patient records synchronized, track outstanding test orders, and follow up on pending results—all triggered automatically when someone submits this form.

Professional, compliant healthcare forms

This template is designed with healthcare workflows in mind, featuring clear consent language, secure data handling, and professional medical terminology. While Paperform is SOC 2 Type II compliant and suitable for many healthcare applications, please note that Paperform is not HIPAA compliant, so evaluate your specific regulatory requirements before deployment.

Get started with this Clinical Laboratory Test Request Form template and bring efficiency, accuracy, and better patient care to your diagnostic testing process.