Free template
Lab request form template
A request the laboratory can process without a phone call: the sample, the tests and the clinical question on one page.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What it asks for
What is on the formThe secretary completes
- Practice details, date, laboratory and request number
- Patient: name, date of birth, MRN and address
- Sample: taken, by, type and fasting status
- Tests to tick, from full blood count and renal and liver profiles to HbA1c, thyroid function, vitamin D and CRP
- Routine or urgent, GMS-eligible or private
- Clinical details
- A note for the patient
- Sign-off: name, qualifications and Irish Medical Council number
Using it well
- Check the tick-list against your laboratory's own request requirements before first use.
- Clinical details help the lab: say what you are looking for.
Open it in the sample practice
The sample practice is the real Ask Brigid on invented patients, open without a sign-up. This document joins its Library with the next sample-practice update; the Library already holds the practice’s templates.
Sources
- The shipped template's field list (Brigid stationery v12), read 24 October 2026
Checked against the sources above on 23 September 2026. Issuers change their forms; check the official page before you rely on a detail here.
In Ask Brigid this paperwork sits beside the diary and the record: Practice management for private consultants.