Online PDF Pathology Request Form

Fast and Convenient support for medical practitioners offering telehealth consultations.

Practitioners wishing to use our Online Pathology Request form for telehealth consultations please follow the steps below.
Please be aware that patients without a valid Medicare card may incur an out of pocket fee for tests requested.

STEP 1: Download and Save the Online Pathology Request Form to your computer or mobile device.

STEP 2. Open the Pathology Request form in Adobe Reader and complete with the following information:
 • Relevant patient information including date of birth and contact phone number
 • Tests requested and clinical history
 • Name of person making the request
 • Provider number and name of medical practice
 Date of request
NOTE: No referrer signature is required.

STEP 3. Email the completed request form to your patient. Please also keep your own record of the services requested.

STEP 4: Your patient must PRINT the completed request form and attend one of our collection centres.