Test Requesting

Instructions for Test Requesting

Financial Data Form (pdf format) – You are REQUIRED to fill out a Financial Data Form.  You MUST complete the form by typing the information.  Please include the completed (typed) form with your shipment of samples.  The Financial Data Form (Word) needs to be completed ONLY ONCE and re-submitted only in the event of contact information changes.  If you submit a handwritten financial data form, you will be asked to resubmit a typed financial data form before any testing will be started on your samples.

  1. Please download and print the appropriate request form using the links below.  In order to download the appropriate request form, you will need to determine whether you are associated with one of the Fertility and Infertility Branch (FIB) supported centers.
  2. If you are associated with one of the FIB supported centers, you are classified as a B USER.   Click here to view a list of FIB-approved users.  If you are not associated with a FIB supported center, you are classified as a C USER.
  3. Please submit one form per assay, i.e. one request form for Estradiol, one request form for Testosterone, etc.
  4. After printing the request form(s), fill in all of the designated fields and include the request form(s) with your shipment of samples.  Please note, the request form has a “Method of Payment” section that needs to be completed.  If you are using a PO#, you must include that number at the time of submitting your samples.
  5. If sample volume is limited, please prioritize the order of assay preference.

Financial Data Form  – PDF or Word


Request Form for C USER – EXTERNAL USERS

Request Form for C USER – INTERNAL TO UVA

Samples Contain HAZARDOUS AGENTS – Disclosure Form

Shipping Instructions and Address