A completed Test Request Form (TRF) is required for all tests. Samples that arrive without a fully completed TRF will be delayed. Inclusion of a Patient Information form is strongly recommend. This enables the most optimal interpretation in reporting results with respect to observed clinical findings.
California State regulations (Business and Professional Code Section 1288) requires a signature from individuals licensed to practice in the healing arts, currently limited to medical physicians, who wish to order laboratory testing. NOTE: This does not apply samples originating from a referral laboratory requested by a medical physician. Get further details regarding physician signature requirements .
If you would like to use our electronic form, please complete all required fields, and clicking the "Print and Submit" button will print the form and then ask if you want to also submit the encrypted data securely to us for preprocessing. Printed copies of all required forms must always be included with the specimen. Do NOT transmit forms via regular email, which is not secure. Even if you have only the Reader version of Acrobat® (versions 5.1 through 6), you will be able to save a copy of the form with your data by clicking the save button at the end of the form.
- CMDL TRF Submission Checklist
- Insurance-Test Request Form (TRF) - Fill the TRF electronically and print it
- Insurance-Printable Test Request Form (TRF) and Test Listing with CPT Codes - If you fill the TRF by hand, please put a check mark next to each test ordered.
- Institutional and Out of pocket-Test Request Form (TRF) - Fill the TRF electronically and print it.
- Institutional and Out of pocket-Printable Test Request Form (TRF) and Test Listing with CPT Codes - If you fill the TRF by hand, please put a check mark next to each test ordered.
- Prosigna Test Request Form
- Request a specimen collection kit
- Cancer Patient Information Form - for p53 (TP53, Li-Fraumeni Syndrome) and CHEK2 - for p53 (TP53, Li-Fraumeni Syndrome) and CHEK2
- General Cancer Patient Information Form - for PALB2, MUTYH and STK11
- CDH1 Patient Information Form
- EGFR Patient Information Form
- Marfan Patient Information Form
- Hemophilia Patient Information Form
- HNPCC Patient Information Form
- PTEN Patient Information Form