Diagnostic Solutions Sample Requisition (Cash-Pay)

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

• How Your Completed Requisition Should Look

How to Fill Out Your Requisition

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