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Courier services pick-up request form
Sentara Reference Lab Solutions
Date
Time
Client code
Pick-up contact information
Contact name
Contact number
Extension
What time does your office close?
Pick-up location
Business name/Department
Street address
Suite/floor/room number
Zip code
Drop-off contact information
Contact name
Contact number
Extension
What time does your office close?
Drop-off location
Business name/Department
Street address
Suite/floor/room number
Zip code
Timing
Routine
Stat
Future date
Type of pick-up
Specimen
Mail
Money deposit
Boxes
Medical equipment
If picking up a specimen:
Temperature
Room temp
Refrigerated
Frozen
Location
Lock box
Inside building
Any additional notes
Submit