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Skin biopsy request form

Neuromuscular Clinical Laboratory 2026

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4.2 out of 5

41 votes

The document is a Muscle, Nerve, and Skin Biopsy Request Form from the Neuromuscular Clinical Laboratory at Washington University School of Medicine. It outlines the necessary information for submitting biopsy specimens, including patient details, billing information, clinical data, and specific tests requested. The form provides instructions for handling and shipping tissue samples to ensure proper analysis and includes contact information for the laboratory.

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Click ‘Get Form’ to open the Neuromuscular Clinical Laboratory form in the editor.
Begin by filling in the 'Referring Institution' and 'Patient Name' fields. Ensure that all information is accurate to avoid any processing delays.
Next, provide details for the 'Requesting Physician,' including their name and signature. This section is crucial for authorization.
Complete the 'Patient Billing Information' section by attaching a copy of the insurance card or providing necessary details if not available.
In the 'Clinical Data' section, enter relevant diagnosis, history, and indication for the biopsy. Be as detailed as possible to assist in accurate testing.
Select the tests requested from the options provided. Make sure to check all applicable boxes for histochemical and immunocytochemical stains.
Finally, review all entered information for accuracy before submitting your form through our platform.

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Versions	Form popularity	Fillable & printable
2022	4.2 Satisfied (41 Votes)
2013	4 Satisfied (31 Votes)
2003	4.7 Satisfied (24 Votes)

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