RPh Labs forms
Download required forms for testing & billing
Every form is grouped by category below. Download, print and submit it alongside your PGx, DME or other diagnostic test kit.
Three forms, all PDF
How it works
Pick the form you need, fill in the required sections, and return it with your test kit or hand it to your provider. Our team handles the rest.
- Identify the form category you need
- Download the form as a PDF
- Complete every mandatory section
- Submit it with your sample or give it to your provider
Forms directory
Every available form and document in one place. Use the tabs to move between categories and open the forms relevant to you. New categories are added as they are released.
Requisition forms
1 form
Use these forms to request lab tests, including specialty and routine panels. They streamline the process for healthcare providers and keep processing accurate at the laboratory.
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Standard — New order, PGx requisition form
For self-pay patients.
Medicare ABN & insurance forms
1 form
Complete the Advance Beneficiary Notice (ABN) and insurance billing forms required for Medicare coverage and insurance claims. Accurate submission keeps processing and reimbursement moving.
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Medicare ABN form
Required before testing when Medicare may not cover the service.
Pharmacogenomic test forms
1 form
The forms needed for pharmacogenomic testing. Complete information means reliable results and medication guidance matched to the patient's genetic profile.
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Insurance billing — pharmacogenomic testing order form
Use when testing is billed to insurance rather than self-pay.
Get the latest forms and updates by email
We email new and revised forms as they are published, so you are never submitting an out-of-date version.
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