Customized Test Panel Request Form

Many of our clients have a group or groups of tests they order on a regular basis. In an effort to streamline the test ordering procedure and minimize errors, we offer the ability to create and name test panels. Please fill out the information below to send in your request. Make sure to include a name for each panel you create (for example PCOS, Donor1, PracticeName1 or PhysicianName1) and then list all of the tests you would like to be included everytime you order that panel. Once the custom panels are created Unilab will send a reference guide with the name of each panel and their associated tests.

*Note: You can supplement test panels by ordering additional tests on top of what is already included. However, you will not be able to alter a panel itself by removing individual tests as only the panel name will show up when ordered and not each individual test.

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel:

Test Panel Name:                                                                            Practice Name:

Tests to be included in the panel: