IPC Histology Request Form

Only needed if different pickup person than requestor/lab

Please separate multiple e-mails with a semicolon

Select all that apply. Additional fields will appear when requests are selected. A list of IPC Services can be found here.

Commonly selected requests are defined here. (these links will not automatically open a new window)

Please provide tracking information if being shipped

Please only select if submitting for Experimental Pathology Program (EPP) or Pathology Services Unit (PSU).

We will generate a PO for billing purposes.

Please list sum of all samples being submitted or number of cassettes being requested. If submitting for any hourly charge, please put 0)