Run a cleaner, more professional practice — starting with the paperwork. This fully editable Laboratory Request Form gives you a complete, compliant, ready-to-use document in minutes, not hours.

What You Get:

• 1 x Microsoft Word file (.docx) — fully editable
• 2-page Laboratory Request Form
• Page size: US Letter (8.5" x 11")
• 10 structured sections covering every element of a complete lab order
• Pre-built checkboxes for 70+ commonly ordered laboratory tests across 11 clinical categories
• Placeholder fields for your practice name, logo, address, and contact information
• "Confidential Medical Document" footer pre-included
• ICD-10 code field for diagnosis/clinical indication (required by most labs)
• Provider Authorization section with signature, date, and time fields
• Freebie included inside

Perfect For:

• Family Nurse Practitioners (FNPs) launching or running a private practice
• Physician Assistants (PAs) in independent or collaborative practice settings
• MDs operating outpatient, concierge, or direct primary care clinics
• Medical offices needing a standardized, customizable lab ordering workflow
• Healthcare providers who want to eliminate handwritten or outdated lab slips

How It Works:

1. Purchase — complete your order and receive an instant download link via email and your Etsy account
2. Download — open the .docx file in Microsoft Word on any device
3. Customize & Use — add your practice name and logo, adjust any test categories, then print or send digitally

Important Notes:

• For personal and single-practice commercial use only. Redistribution or resale of the template itself is not permitted.
• This is a digital download — no physical item will be shipped.
• Due to the instant-access nature of digital products, refunds cannot be issued once the file has been downloaded. Please message before purchasing if you have any questions.
• This template is provided for administrative and organizational purposes only. It does not constitute legal, medical, or compliance advice. Buyers are solely responsible for ensuring all forms comply with applicable state, federal, and local regulations before clinical use.

Whether you're setting up your first private practice or streamlining an existing medical office, having a professional laboratory request form is essential to clinical credibility and lab compliance. This printable lab order form template is designed specifically for FNPs, PAs, and independent MDs who need a complete, editable medical form that covers everything from hematology and metabolic panels to tumor markers, hormone levels, and infectious disease serology — all organized in a clean, user-friendly layout that saves hours of administrative work.

Your practice deserves documentation that works as hard as you do. Click Add to Cart now — your download is ready the moment you check out. Have a question first? Send a message and you'll hear back promptly.