---
title: Clinical Laboratory Test Results Request Form Template | Paperform
description: Professional form template for patients to request clinical lab test results with authorization, date range selection, and physician delivery coordination. HIPAA-friendly and secure.
url: "https://paperform.co/templates/clinical-laboratory-test-results-request-form"
type: static
generatedAt: "2026-03-28T00:43:20.511Z"
---

[← Back to free form templates](/templates/)    ![Clinical Laboratory Test Results Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/clinical-laboratory-test-results-request-form.png)
    [Preview](https://_preview.paperform.co/ai-template/clinical-laboratory-test-results-request-form) [Use this template for free](/create?ai-template=clinical-laboratory-test-results-request-form)    [Request Forms](/templates/category/requests/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Lab Technician](/templates/role/lab-technician/)     About this free form template
### Streamline Laboratory Test Results Requests with Paperform

Healthcare providers, medical clinics, and diagnostic laboratories need a secure and efficient way to process patient requests for clinical laboratory test results. This **Clinical Laboratory Test Results Request Form** template provides a professional, compliant solution that makes it easy for patients to authorize and request their medical records while ensuring proper delivery coordination with physicians and healthcare providers.

#### Built for Healthcare Workflows

Whether you're managing a clinical laboratory, hospital records department, or medical practice, this form template handles the complete request process from patient authorization through delivery coordination. Patients can specify exact test date ranges, provide reference numbers for faster retrieval, and indicate whether results should be sent directly to them or coordinated with their physician.

The form captures all essential information including patient demographics, authorization signatures, and delivery preferences—replacing paper request forms and streamlining your records management workflow. With Paperform's conditional logic, the form adapts based on delivery method, showing relevant fields for physician coordination or direct patient delivery.

#### Automate with Stepper and Papersign

Take your laboratory request workflow further by integrating [Stepper](https://stepper.io) to automatically route requests to the appropriate department, send confirmation emails, update your laboratory information system, and track request fulfillment. You can also use [Papersign](https://papersign.com) to collect legally binding electronic signatures for HIPAA authorization forms and release of information documents, keeping all signatures linked to the original request.

#### Perfect for Healthcare Providers

This template is ideal for clinical laboratories, hospital medical records departments, diagnostic centers, pathology labs, physician practices, and any healthcare organization that needs to process patient requests for test results. The professional design builds patient trust while the structured format ensures compliance with medical records regulations.

With Paperform's SOC 2 Type II compliance and robust security features, you can confidently collect sensitive patient information knowing that data is protected. Forms can be embedded on your patient portal, linked from your website, or sent directly to patients via email—providing a seamless experience that reduces administrative burden and improves patient satisfaction.
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