Slide Review and Consult Request Form - UW Medicine Pathology 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, date of birth (DOB), sex, and social security number (SSN). Ensure all details are accurate for proper identification.
3. Next, complete the 'Requesting Institution' section. Provide the institution's name and address, including city, state, and zip code. This information is crucial for billing and communication.
4. In the 'Payment Options' section, select your preferred billing method. Choose from options like self-pay or institutional billing. Fill in insurance details if applicable.
5. Proceed to 'Specimen Information'. Specify the medium (slides or blocks) and provide any additional case details required for processing.
6. Finally, ensure you sign and date the form in the 'Physician Signature Required' section before submitting it through our platform.

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