6PT
SixPoints
·
Lab Order Submission
Lab Order Request
Complete all required fields and submit. A confirmation will be displayed when your order is received.
Patient Information
Facility
*
Select your facility…
Patient
*
Select facility first…
Order Details
Ordering Physician
*
Tests Requested
*
Diagnosis Codes
(optional)
Additional Diagnosis Notes
(optional)
Collection Schedule
Preferred Date
*
Preferred Time
(optional)
Recurrence
One-time (no recurrence)
Daily
Weekly
Monthly
Quarterly
Annual
Recurrence End Date
(optional)
Additional Information
Fasting required for this order
Special Instructions
(optional)
Submitted By
*
Contact Phone
(optional)
Submit Lab Order
✓
Order Submitted
Your lab order has been received and is pending review.
A phlebotomist will be assigned shortly.
Submit Another Order