Submit this online form to order bound pads of B5 test request forms. These B5 pads are only suitable for handwritten test requesting and are generally used for ward rounds, home visits, and nursing home test ordering.
Note: the details you submit on this form below will be used to populate and pre-print the “referring doctor”, the referring doctor’s “address and provider number”, and any permanent “copy to institutions” onto the B5 test request forms
Only complete this section if you want a default “Copy To” institution or doctor to be printed on every request slip.
