Request Forms

The Biochemistry and Haematology Request forms have recently been redesigned. The separate forms for Clinical Biochemistry (green) and Haematology (red) have been removed from use and replaced with a single, combined Haematology/Biochemistry request form (see link below).

There is now a separate purple request form for Immunology requests, which includes requests for transplant immunology, cellular immunology and immunosuppressive drugs.

Biochemistry/Haematology request form - instructions for completion (NHS internal link only).

Pathology Sample and Request form labelling policy

Please note that the patient must be positively and uniquely identified on both the request form and the specimen container. This requires a minimum of 2 independent identifiers on the sample and all three identifiers on the request form.

Identifiers are:  Full name - forename AND surname, NHS number and date of birth.

You must also supply relevant clinical details, name of responsible clinician, address and postcode and telephone number of patient and location for return of the report.

LTH Trust and BTH Trust operate a strict policy on request card and specimen labelling.  Failure to meet these requirements will certainly cause delay in obtaining results and specimens may be discarded where identity is in doubt.

It is the responsibility of the requestor to ensure that request forms and specimen labels are completed correctly, even if these duties are delegated. Click here for the LTH labelling policy. Where requests are rejected, or where another issue means that a result cannot be generated the primary route of communication is via the results server where full details of the reason for rejection will be recorded. It is not possible for the laboratory to communicate all rejected/problem requests via telephone. 


Where a request is rejected it may be possible to process an UNREPEATABLE specimen following completion of the declaration form.

Semenology Request forms and Patient Information

Semen Request Form

Semen Analysis: Information for Patients

Post-Vasectomy Patient Information

Page updated: 20/06/2013 | Updated by: Micheal O'Sullivan

Blood Sciences Request Links