Public Pickup Form

Requesting Facility Name *

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Facility Name is required.

Facility Pickup/Dropbox*

Residential Pickup*

Pick-Up Address *

Pick-Up Address is required.

Requestor's Phone Number*

Sample in Dropbox is required.

Notes

Pick-Up Time Window *

For all samples except blood, the AnyTime pickup slot may be used.
For pickup requests that include blood samples, please use the 6:00-15:30 pickup time slot.

Pick-Up Time Window is required.

Before submitting, please ensure that all inputted information is correct For assistance, please call : (702) 229-2223 ext:108