The test requisition form travels with your laboratory kit. It records patient information, relevant health context, the panels requested and when samples were collected. The Understanding the Test Requisition guide asks patients to complete all sections on both sides of the form. Read the printed prompts carefully and contact the laboratory or your healthcare professional if you are unsure how to answer; do not guess.
Patient and cycle information
The first section collects patient details, including date-of-birth information. Section 2 records current menstrual status for women, which the guide says is important context for interpreting hormone testing. Use the options that accurately describe your current status.
Symptoms and thyroid questions
Section 3 is a patient-reported symptom checklist. The form uses a 0–3 scale: 0 means none, 1 mild, 2 moderate and 3 severe. Rate what you experience rather than trying to predict what a result should show. Section 3a is optional and is requested only when evaluating thyroid dysfunction.
Hormones and medications
Section 4 asks about hormone and medication use, including prescribed dose, delivery method, how long it has been used and the exact time of the last dose. The guide notes these details are important when evaluating results. Provide accurate information and do not stop or change prescribed medication just to complete the form; ask your prescriber if you need help recording it.
Sample times and requested panels
Section 5 is for the date and time each sample was collected. Record this at collection time, using the labels and format on your kit. Section 6 is where the test panel or panels are selected by checking the appropriate boxes. Match these selections to the test you purchased and the requisition that came with your kit. Complete the remaining fields as labeled on the form.
Signature and provider information
Section 8 is the client signature for authorization and/or consent to laboratory testing. Section 9 contains health-provider information; the guide notes the provider’s name and address will print there. Check that the details are present and correct if this section applies to your order.
Before returning the form
- Complete all sections on both sides, including any fields marked for your test panel.
- Check that sample dates and times match the labels on your specimens.
- Make sure symptom ratings and medication details are complete and accurate.
- Include the signed requisition with your samples and other kit paperwork as instructed.
For related testing options, browse Multi Hormone Profile Tests. The correct panels and samples vary by kit, so use the product details and collection instructions supplied for your specific test.
This article explains the requisition form only. It is not medical advice, a diagnosis or an interpretation of test results. Discuss personal health questions with a qualified healthcare professional.