PLEASE PRINT OUT THE REQUISITION FORM FROM YOUR RUPA PATIENT PORTAL (IF AVAILABLE) AND SEND IT BACK WITH YOUR SAMPLES.
If no requisition form is available in your Rupa patient portal, please fill out the blank form and send it with your samples.
These instructions are ONLY for cash-pay orders. For tests ordered using traditional Medicare, fill out your requisition following the instructions HERE.
How to Fill Out Your Requisition
PLEASE PRINT OUT THE REQUISITION FORM FROM YOUR RUPA PATIENT PORTAL. Do not fill out the blank requisition form included in your kit.
Please note that your requisition may look slightly different depending on the test you ordered. The information you need to fill out will be the same no matter how your requisition is formatted.
How Your Completed Requisition Should Look
